HomeMy WebLinkAboutBLDE-22-006001 •
Commonwealth of Official Use Only
41_ Massachusetts Permit No. BLDE-22-006001
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:4/19/2022
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 electrical work described below.
Location(Street&Number) 2108 HEATHERWOOD
Owner or Tenant PAYNE VIRGINIA M TRS Telephone No.
Owner's Address PAYNE JEFFREY L TRS, 2108 HEATHERWOOD,YARMOUTH PORT, MA 02675
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: Replace roof top disconnect UNIT 2108
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
Initiatine Devices
No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices
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 Ballasts Data Wiring:
Heaters Siam 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: KELLY, MCKENNA AND DAVID ELECTRICAL CONTRACTOSR, INC
Licensee: Connor K Tilton Signature LIC.NO.: 22722
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: 5083178885
Address:398 Court Street Unit 3R, Plymouth MA 02360 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 my
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: $80.00
, dessowatook eif • • „in use i
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: 1 i LhrOANdadinM Pn*No. fl...i ..d01, i
APPLICATION FOR PE - IT TO PERFORM ELECTRICAL WORK
All sorb 1111be yolbosed is ecoodnoo with dm Slostrical Coda MC).527 ma 12.00
(PLEASE RUNT IN Rik OR TYPE ALL NFORAIATION) Dote: 4- I 4-
city or Tows at \(or v."Ouk.\ To the&rector of Wirer
By this application the oaderdpcd gives ratio gelds cella° *. to peril=the electied wok dumbed beloir.
Lesotho fkrist as Number) 1 00 444 0. 3--t_.,cod -1 .- \1C.r mo k AL
Owoor or Tomei Kt(-A-It..t^l,-4C)od - K ..-NS-)c-NCA TeWhows No. 9Sza-73ti_8-1a5-
0wrar's Minas .(.‘k-- g (")
Is Ids pore*hi wasionaties with a Maass Yes 0 Ns 0 (Cho&Appropriate Ilas)
Pupae dloildiag 1 , . . Na.
Islikg awoke __ Asps /Vets i 0 thiegni 0 Ns.ef Mean
Nuribakft ........_ Awes ?,.......Vdth I 0 Vadgrd 0 No.dial=
Naathar sitersises mad Awrgefdty
laced ow oil Mho of Paltered Itledrical Wale
j BOARD
OF FIRE PREVENTKM REGU., LA11°Ndiee .ikeliffri andkFIlvdvalici aseilkal' the S53-C3°
% ‘‘ • * 2_
CA
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No.discoed LT andro Ns.ca 6, • i )
No.dlailaireOldete No.gnat Tabs Geweneen KVA •.
1 ri
Ne.offLoolosliu lod Li 0
-- '
No.allsoptade thither No.dee , tin ALARMS No.elt Zooms
6 )—--
Ns.dliwItekes Ne.dense
L ALA.
Ne.finbrs Nandmr • ..., eg Aaron Demliiii "
Tomo
No.(Wade Upson ---
. , li.f7"_____- __1, i AJ•44,w04 .,• .
4.1 ....,
Taste MINIM 1111111111-__—__ _P____J____ i .)
No.fiDkammlims Area VW Lead 0 .' ' 0 Oil.
Ne.of Dryers Hoeg
Kw Dais WkbrIP
Ebotatro _Nod 1.//____ Ihr
Teed ma
No.Hydrowewep Netleade No.of _.,A.
Wing -, adetkeist*Oa Veldre4 mai reildralley de eflItr
theimated Valve of Electical Watt (Wits requited by mimicipai policy.) '
WodcoSta ________.bipeds's:a to bs ragweed Ia — . . with MEC Rule 10,and upos casphdoo.
lallURANCI COV------I--1% Union weiven by dts mot,no , - ,i ri kg the pohnuesoe of doctrical sok may loos oak
die Boom provides proof of liability lowentio - . Nonaphtsi operation"coyotes or he substentW egokskris The
undersigned codifies the sash coves eps is In thaw,and Ito 1 grad dome to the posit bobs office.
CffiCL ONE DiSURANCII !Z BOND CI arnsa 0 (llpocify.)
/ape maitre,pales exi peek&el &matt ea We oppgeofee It awe mit eempleta
11111M NAM.: \ k- 11C.IVO.:_aaaiayq
Ligalla----- -n1311C-=±11"-------- ...C... ------- L1C NO4—....—
afesiceNe ow nomers-es the&ewe weber Ike) Rim Td.Ple.s 502--317-2-8V-S-
Addres 3 + ( • oa (0 Att.TgLN•a.----
*Pe MALL.c.147,s.57-61,woo*/work raquires of sir IAvO1s Lin.No.
Omura twinaAPIcii WAIVR: I am ewers tbat tto License does not have the liability ioeureocs eavems man
ffl.'''':"------1-..11....a4Infa.below.I body weirs this rayallulete I so the(cheek ow owaws
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