HomeMy WebLinkAboutBLDE-22-006004 Commonwealth of Official Use Only
l: :' Massachusetts Permit No. BLDE-22-006004
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) 2208 HEATHERWOOD
Owner or Tenant SCHNEIDER ELIZABETH Telephone No.
Owner's Address 2208 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: Replacement roof top disconnect(UNIT 2208)
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
nd. ❑ g rnd. ❑ No.of Emergency Lighting
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
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER:
No.of Devices or Equivalent
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
I certify,under the pains and penalties operjury,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.)
Address:398 Court Street Unit 3R, Plymouth MA 02360 Bus.Tel.No.: 5083178885
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) my
Owner/Agent 0owner ❑ owner's agent.
Signature
Telephone No.
PERMIT FEE:$80.00
nO . -<<o
I 2.2z..tee__
�r 'In ally
+ No. C -6
,00/
';' I) I el ging
Occupancy and FanCbsci ed %16.bb
OF FIRE - _ . REGULATIONSvon
APPLICATION FOR PE IT TO PERFORM ELECTRICAL WORK
All week to be p-Jaeaed is e000tdseoe with the 131oct csl Cods WI527 CM 2
(muse PRINT IN INK OR TYPE ALL 0 ItA61770R0 Date 4 - I y - a,d a a_
ay or Town of To the Inspector 1h :
applicationBy tide n cc her•, to , the deeded wit dererkedbelow.
Loeail-o font�*Ntambill 1 OC . H-e ckkxr- -)bCd. �r- /o.r wl ht‘44�
Owner mermaid At(ALLY' 4P kk ii 5l. 'Cr, ., Taisphn a No. 5D%--)1V7 -%aB
OwM.'e Addron v n tt 4 a208
Ii ale MI*to iMeilidien witbabelkike Yes 0 N. 0 (Clank ApsOri.*s
P.rpowa< e .r1c2r►c_� O Ns.
Mal Earplie Asps I VIM . 0 UMW&0 No.et'!-' -,
A / V ' 0 USIA 0 NI&dMsisri
hbuahar etiroident and Amposity .
Leese no aid Nala+i.rProposed `R ,\Gc Q i.- 0 C �I oS ---r6nr A/e
,anr\Qc k-s •kn U r\ik- 46 aaVlr
«, estrotiknoinbk..7bem Iv the bnear elks,
No.dammed Liashadra No.ei a Trap dersgra 15"
ind Gewerat~es KVA
No.�[ Above ri �N ra.or � R
No.eRI
No. FIRE ALARMS INo.of Zoos
No.i[ M Oeliili Vo.otDoiiioi
so.et
. Toed
Na othtrhes y.�
No.d T No.otANrelli Divans
I% ... r ''"
No.*Moto ' ' F Der
heed® ,«� � - 13 Obr
Now lt
Ns.gingers SoesitylioNtwa
No ammo orymolvolot
Wiffraft Root Das Wag
KW 1 Naof Berke or
Soden �- t a
No.opdnNllo Estheils No.of HP No.stiletto or
Or DM
Ana adilttosei ales r if Er
Badmatad Vibe of Wadc
Wodg to -, , , robs , in , , , wig MEC Rule 10.and epos eoap iedoo.
INSURANCE COVIAGE: Unica waived fry ths Cralff,110 . I 1 1} IN tho pitmans of oisoidad work moy Moe yak
provides prof Ofiability t ,, ., , , arils The
the nadtaione as each wow.bib pr f of same to the wok hods office.
CIMCL ONE: INSURANCE ® BOND ® , I
zoo*,eider 10epan e• , &a dw ow Ibis eptieeden b swi awlmir
PmM NAND TI /-nv, 1-I e.c .rc c s n c . LICC.NO.:a'a'13a A
UOMNIN l�c�vypnr----tizhYN �.Te{.I�O.=`�$•3l'Y'-�gi�j
A ow Q tG✓ �] t rn b AL TA
-amp"
mew km)
ddreoet
3�$ C.o�r 5�'• "8"Limon: Lb.No. —
*Par M.O.L.c.147.e.57-61, 1 >, ' ' ' " ' ` ' �
OWNIR'S EVID ANCE WAIVER: I am,awes due the" -<�� . not how the
liability istontantn;somas- -_...........hateoLI hereby rya this sequiteaswo. I am the(cheat foe)0 acme ❑oRiaw'e ai