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HomeMy WebLinkAboutBLDE-22-007365 of Commonwealth of Official Use Only fi Massachusetts Permit No. BLDE-22-007365 llikBOARD 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:6/22/2022 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 electric work described bedgw Location(Street&Number) GREENOUGHS POND ©rN'Pia �$ 10 Owner or Tenant CAPE COD COUNCIL OF BS A Telephone No. Owner's Address 247 WILLOW ST,YARMOUTH PORT, MA 02675-1744 , 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 800 Amps Volts Overhead 0 Undgrd Il No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: UFER roundin . B 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- ❑ No.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 No.of Detection and Ini iatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tori 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 Water No.of Devices or Eauivalent Heaters KW No.of No.of Ballasts Data Wiring: Siens No.of Devices or Eauivalent 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 operjury,that the information on this application is true and complete. f FIRM NAME: TYLER W PAYNE Licensee: Tyler W Payne Signature (If applicable,enter"exempt"in the license number line.) LIC.NO.: 22091 Address:5 JANS PATH, HARWICH MA 026452458 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. . I PERMIT FEE:$80.00 I 12-,5/2 eej rrr (5o 5i o s ag/euN 4 ;-A, 2c50 1 Commonwealth of Massachusetts Official Use Only 1 r-----r-vi-- t Permit No. 2-2- -73 65" .,�_ Department of Fire Services ' f i i Occupancy and Fee Checked , ., BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/051 (leave blank) 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: Ii la-a-i s-a- City or Town of: y" ,.. -j 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) L9 -7 P1r - w_ S Owner or Tenant S(2),{-s of--• mP v Telephone No."1]l.( 9.0_32L Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing ServiceM Amps IZ'j / Volts Overhead ❑ Undgrd al No.of Meters j New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: j-c-i — 1i.-vc1/I Completion of the following table ntay be waived by the Inspector of Wi,es. 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 Swimmin Pool Above In- Ivo.oUt mergency Lighting Swimming grnd. Li grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of'Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW ,No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heatirg KW Local❑ ConnectionMunicipal ❑ Other No.of Dryers Heating Appliances KW Security S.ystems:* No.of Water No.of No.of Devices or Equivalent Heaters KWNo.of Data Wiring; 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: (p I 2-1 I)-d-- Inspections 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 Providesproof 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 ❑ (Specify:) I certify,under e pains and penalties of perjury,that the it formation on this application is true and complete. FIRM NAME:?th{ y NE ELEC," .1 ' i,. • LIC.NO.: ` Licensee: TAE . \N, PAy NE Signature � 'tel LIC.No.:1,2•• (If applicable enter "exempt" in the license number line. / Bus.Tel.No.: ��, Address: 0:o. BOX tot SOU•c H 1t line.) iCli t mtli 0 LC0 lo I Alt.Tel. Security System Contractor License required for this work;if applicable,enter the license number here: No.: nvi1� .;;, 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) Owner/Agent ❑owner 171 owner's agent. Signature - Telephone No._ I PERMIT FEE:$ I