HomeMy WebLinkAboutBLDE-22-006000 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-006000
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) 2111 HEATHERWOOD
Owner or Tenant RUCH FRANCES C Telephone No.
Owner's Address 2111 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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement of roof top disconnect#2
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
Initiating Devices
No.of Ranges No.of Air Cond. Ton l 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 ❑ 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 Signs 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: $80.00
Use Only
+ al P�nit rto.
°ccuPencY
and
1 ®F FIRE PREVENTION REGULATIONS blank
APPLICATION
T FORM LECTRICAL WORK
All work to be parformed in madam with the ,, - Electrical Code(Ma 527 cha 12.00
(PLEASE PRINT IN INK OR TYPE ALLINFORMATION) Dnte: LI/ i v( 2.o2.Z
City or Town of: Y Co.r YV1 c 3 To the Inspector of Wires:
By this application the undersigned gives es of his or her intention to perform the electrical work described below.
Location(Street es Number) I'bo N-e(.-t►.er . o o d -IN-. `/c.rw)oUil- .
Owner or Tenant 1-1-e c..k.Lu-k..,rho A % 1•(►.:3s lo►., Telephone No.50•_tc-al. -&& S
Owner's Address t., en i+ 2t l l
Is this permit in cmJuaetion with a building Yes 0 No ® (Cheek Appropriate Bee)
perpoue of CLnS,,k, ,, e 1 Utility Autborizadon No.
MSc Service® Amps / Volts Overhead 0Uadgrd 0 No.of Meters
New Service Amps / Volts Over 0 Undgrd 0 No.of Meters
Number of Feeders and Ampadty
Loeat ea and Nature of Prompeed Electrical Work: &t,\c,,.e .3w.,,ca.' UC (Lot\cat t,f W1 c_
A\SW nr"4 'vn V n i`+ 2 o,��aab1 be waluadby the Ohm
o. b1�1
No.of Recessed L of Rot Tubs Generators A
Na of Above In. ri No.of
No.of : ' Seed. Li1BattR►UIM$
No.of Banters FIRE ALARMS INC.of ZonesNo.�[Receptacle Omelets No.of Detailou and
No.of Switches No.of Burners EtdtlefbM De"viti�
Total
No.of Ranges No.of Air Cond. Tons No.of Meeting
Devices
: Pump I Number J Tous +K „. No.of Selma
I ^(- ,I
No.or Waste D Totals: H�ocal❑M � I'- , � �
No..of Arm KW -Security Systeoss:*
No.of Dryers H KW of Devices w Za:drd
eat
tie.of Water�s 'No.of No.of .
�r I No.•fDavices or L____I
SIM '16' ,
Na Bathtubs No.of MotorsTotal ;I, Ti of ' M - I
1JTSSR: Attach additional detail Vas1vsd.or or"es"trad by dre laspecear of lrh
Estimated Value of Electrical Work: d by municipal policy.)
Work to Stan: to be requested in accordancewith MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no .. 1 III far the performance of electrical work may issue unit
"completedthe licensee provides proof of or its aubst nt:aal equivalent The
undersigned certifies that such coverityage
insurance is in fine,and has exhibitrd proof of same to the permit issuing office.
CHECK.ONE: INSURA ,® BONDTHER 0 (Specify:) sapp Is tree and co�r�pl
I car 1 that in en
LIC.NO.:aa�as
Fast NAME: —�C��k�Y. �ln c,k,r i c. Z'�c •Signature.C�7 � LIC.NO.:
I,keasem Wvsv���r� Ikk,vnTeLNN.*9i)F:ASP
ett
'" "In the License number line) , Bus.
(flu (1,-e r r 0..) AIt.Tel.Noe.._
' 3 work of Public Safety"S"License: Lie.No.
*Per M.O.L.c.147,a.57-61,
OWNER'S INSURANCE W : I am away the Licensee does not k liability insurance owner El owner's si
req tired by law. By my ve 0
I PERMIT FEE:$