HomeMy WebLinkAboutBLDE-21-004408 o• ' Commonwealth of Official Use Only
''i\ Massachusetts Permit No. BLDE-21-004408
"``..' 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:2/4/2021
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) 92 WAMPANOAG RD
Owner or Tenant Steven Crowley Telephone No.
Owner's Address
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: Miscellaneous per attached.
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. 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 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security No.ofSystems:*
Devices s:r Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters 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: 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: ARTHUR P DOHERTY
Licensee: Arthur P Doherty Signature LIC.NO.: 17197
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:372 YARMOUTH RD, HYANNIS MA 026012043 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:$75.00
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O ': w�' cx P 0�] Permit No. Z- L - H y 1063
�l _ fik. 2)e o f Jiro Serviced
rJ i1 r Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev,1/07] (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: 2.73/Z.0 at
City or Town of: YARMOUTH_ 1 To the Inspector of Wires:
_ By this application the undersigned gives notice of his or her intention to perform the electrical work described below. .
cv Location(Street&Number) 9 Z lvt4m MA) 0A (-, g b
•
4. Owner or Tenant s iJ= V 4! Cg.d cv j v_y Telephone No.
• q Owner's Address
�) Is this permit in conjunction witha buildingpermit? Yes
- � // TO No El (Check Appropriate Box)
a Purpose of Building Df J..l€_,I t i N 6-- Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters •
• E New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
3 •z Number of Feeders and Ampacity
Location and Nature of Prop
osed Electrical Work: 0 IA./" —� •
a•
• Completion of the following table may be waived by the Inspector of Rues.
o. Total
Lit No.of Recessed Luminaires No.of CeiL Tran-Snsp.(Paddle)Fans rant KVA
Sx' Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Poo, Above ❑ In- ❑ 1vo.of Emergency Ltgatmg
trod. grad. Battery Units
ti No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 'No.of Detection and
No.of Gas Burners Initiating Devices •
IQ No.of Ranges No.of Air Cond. Toons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: — Detection/Alertingpevices
No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other
No.of Dryers Heating Appliances KW Devices or Equivalent
No.of WaHeaters ter KW No.of No.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: 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 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 a BOND 0 OTHER 0 (Specify:) -
Icertify,under the pains and penalties ofperjuty,that the information on this application is true and complete
FIRM NAME: p>Ay'S r(CeLV-0 (:AL Col-co..cmc LIC.NO.:Af'7/t I7
le_ cf.,.;-rZ l6U Signature , ,77, ,(, ^' LIC.NO.:
(If applicable.enter" t"in the license manber line.) Bus.TeL No.: OR -7 2(o 0 009
Address:,5-2 M,P T c(_.,H p,-- i,.J. yA t P1 0 OM /11, 0 2-G•73 Alt.TeL No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER I am aware that the Licensee does not have the liability insurance coverage normally
required Owner/Agent
law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.Owner/
Telephone No. I PERMIT FEE:$
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