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Home My WebLink AboutBLDE-21-006048 4,)� Commonwealth of Official Use Only r= 611 Permit No. BLDE-21-006048 f€ Massachusetts 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:4/21/2021 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) 3 OLD COLONY WAY Owner or Tenant NICKERSON GARY N Telephone No. Owner's Address NICKERSON DALE N, 3 OLD COLONY WAY, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes ❑ 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: Wiring for post light. 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- CINo.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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 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 Data Wiring: Heaters Siens 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: WALTER W KELLY Licensee: Walter W Kelly Signature LIC.NO.: 21302 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 MONROE LN,WEST YARMOUTH MA 026732731 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 7 -_ mmormcaltfs oil s-sssc iz i - _ Official Use Only ' �7 —��'k agfnarf o .irs J Permit No. (�L-1 �' arrrices t` Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Ii07j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(lvfE ,5 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMQTIOA9 Date: 4 , 01/ City or Town of: YARMOUTH To the Inspector of Trues_ By this application the><taderigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) '3 c' C O L0/ I-- G-! Owner or Tenant Pet Le__ it j 1 Cu rS a_,,, Telephone No..1P-- zi C. Owner's Address -'._-- D2 -gipe 9'f)7 Is this permit in conjunction with a building permit? Yes ❑ Ido fit. (Check Appropriate Box) Purpose of Bud a � Utility Authorization No. Existing Service Amps I Volts Overhead D. Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampacity _ O Location and Nature of Proposed Electrical Work: IJ f�SIC OF /o 7-- L/ - g A— Completion of the followtag table may be waived py the lr.sars.tor al-Wires. '-` No.of Recessed Luminaires No.of CeL�asp_(Paddle)Fans ITo.of Total _ !Transformers I�>r, No.ofL minaireOutlets No.of Hot Tubs !Generators KVA J No.of Lsmiaau�es ISwimming Pool Above ❑ In- ❑ INo.of l,Units cy tmg �- acrid.- md_ !Battery Units 4'" No.of Receptacle Outlets No.of Od Burners ALARMS {No_of Zones No.of Switches No.of Gas Burners _ - No.of Detection and fmnatmu Devices-®-1 No.of Ranges INo.of Air Coed. T ns No.of Alerting Devices 11' Heat Pram No.of Waste Disposers Totals: Number Tons KW Nu. c SelfAjerttai . it of ioalAle-finu Devices .3; No.of Dishwashers {Space/Area Heating KW LocalQ Municipal CorenectioB 0 Offer No.of Dryers {Heating Appliances KW Security Systems:* '� No.of Water No.of Devices or Equivalent IVo.of Heaters No.of Data Wiring: _ Signs Ballasts No.of Devices or Equivalent No.F ydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 1 ' No.of Devices or Equiva ant 4. O i tiJR: • Attach additional detail((desired or as required by the Inspector of Wires. Estimated Value of Electrical Wort (When required by municipal policy.) Work to Start: 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 provides proof ofliability insurance including"completed operation"coverage or its substantial equivalent The undersigned cdrtifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCES BOND 0 OTHER ❑ (Specify:) ,�,} I cerfcfp,under the pains and penalties o .1`� FIRM NAME: �� ,, 1 p s,., �Fe1'l�',mat the��trmation an ibis application is true and complete 1�1CI -- f --1- C Tt Ci r>i�1 �i} F IC.NO. Licensee: t' Ct' E , 3 Ql I. Sxg store 1 f)o. Q. 1 :F_... f A- LIC.NO.: " ta (Ifapplicable enter'exempt"in the licerdAenumber line) _ Vet . Address:`s A4 1')AI to[''mac f A.1 _ I13,0 C T T et f/14 to U /lht - Bus.Tel No:,.� i *Per M.G.L.c. 14 ,s.57-6I,securitywork requires' r „ Alt T�-No_:,�1fjcJ - � Departrrient of Public Safety S"License Lic.No. OWNER'S INSURANCE WAIVER I am aware that the Licensee doer nor 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 ❑owner's agent. store Totanhnna tvn 1 PERMIT FEE:S_50 -'