HomeMy WebLinkAboutBLDE-21-004685 Commonwealth of Official Use Only
4.
.` Massachusetts Permit No. BLDE-21-004685
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:2/18/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 441 ROUTE 6A
Owner or Tenant Michael Daigneault Telephone No.
Owner's Address 441 MAIN ST,YARMOUTH PORT, MA 02675-1824
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement furnace.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- 1:1No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such
coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Nicholas McEloy Signature LIC.NO.: 22642
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:31 Captain Carleton Road,Cotuit Ma 02635 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But
signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
AI, /� /''// �j Official Use Onl
C.onsmonwea[!h o`///aeeac
tie -.(;'=.
=2t Lt6 se 5
,. • ,t c� c-� C'� Permit No.
• ,; spamgo/,tiro Jrrvicad
I; Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) (leave blank)
a
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),S 7 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: `,�.` Off•!
City or Town of: y4Z.e"n.t e(4_71 A To the Ins cto of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street& Number) 1744 /C.f f4
Owner or Tenant / YUS�� m5r/ea_GCI f Telephone No.90/g74/4.1 7y/
Owner's Address _
Is this permit in conjunction with a building permit? Yes 0 No ® (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: lee CV g4ec7' F�viatcc .
Completion of the following table may be waived by the Inspector of Wires.
No.of Total
No.of Recessed Luminaires No.of CeIL-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. ❑ grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No.of Switches No.of Gas Burners Initiating Devices
-
No.of Air Cond. Total No.of Alerting Devices
No.of Ranges Tons
Heat PumpNumber Tons ]KWNo.of Self-Contained
No.of Waste Disposers Totals: 1 Detection/Meiling Devices
Space/Area HeatingKW Local iMunicipal ❑ Other.
No.of Dishwashers onnection
HeatingAppliances KW Security Systems:*
No.of Dryers ppNo.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP 'f el No of Deviceso ors qui a
Na of Devices Equivalent
OTHER:
v.+ Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of EI ctric 1 Work: 35c (When required by municipal policy.)
Work to Start: ct Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO E GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER 0 (Specify:)
I cert(fy,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Cape Cod Electrical LIC.NO.: 22642-A
4
Licensee: Nick McElroy Signature / /`F LIC.NO.:
(If applicable,enter"exempt"In the license number line.) Bus.Tel.No.: 508-566-4489
Address:P.O. Box 1594 Marstons Mills MA 02648 Alt.Tel.No.:
*Per M.G.L.c. 147,s.57.61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent I PERMIT FEE: $ r'o
Signature Telephone No.
Email: Offlcet7acapecodelectriclan.com