HomeMy WebLinkAboutBLDE-21-07090 Commonwealth of Official Use Only
'- cam, Massachusetts Permit No. BLDE-21-007090
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)
City or Town of: YARMOUTH Date
th 6I 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) 2 COUNTRY CLUB DR
Owner or Tenant Sandy&Jennifer Pope
Owner's Address YesTelephone No.
Is this permit in conjunction with a building permit? ❑ No 0 (Check App to Bo
O
Purpose of Building
Utility Authorization No. e
Existing Service Amps Volts Overhead ❑
New Service Amps VoltsUndgrd 0 No.o t rs
Overhead 0 Undgrd ❑ No.of Me s
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Recessed light in kitchen, replace kitchen receptacles, add additional
receptacles, &under counter light.
Completion of the following table may be waived by the Inspe . JP res.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of
Transformers Total
KVA
No.of Luminaire Outlets No.of Hot Tubs
Generators KVA
No.of Luminaires Swimming Pool Above
❑ grnd ❑ No.of Emergency Lighting
No.of Receptacle Outlets Battery Units
No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
No.of Ranges Initiating Devices
No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump Number I Tons I KW No.of Self-Contained
ITotals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW
Local 0 Municipal 0 Other:
No.of Dryers Connection
Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.o of No.of Data Wiring:
Signs Ballasts 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:
Work to start: (When required by municipal policy.)
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 I certify, f perjury,
J,under the pains and penalties o erry'
u that the information on on this application is true and complete.
FIRM NAME:
Licensee: Nicholas McEloy
(If applicable,enter"exempt"in the license number line.) Signature Tel. NO.: 22642
Address:31 Captain Carleton Road, Cotuit Ma 02635 M.Tel.No.:
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.
Signature
Telephone No.
PERMIT FEE:$50.00
Coomosesstmai of MitedachowNo Offtrslal Usee Only
Permit No. r(0 I Q
Zeposime#.1 el glow Sawdeo4
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1 8C?Af �+ Fa Checked d OF FIRE PREVENTION REGULATIONS [Rev. 1�7) S �
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
Ail work to be permed la accordano*with the Massachusetts Etoctricei Cods(MEC),1 ?CMR .00
(PLEASE PRINT ININX OR TYPE LL INPORMATIO Niter �47. a/
City of Town oft �eIW h i To the 1 d qf Hy this appliaestion the Lueders! an to stirs:desoribed below.
Location(Simi eS Mouth ') a— 6o btaal wank
Owner or Tenet S R i'V D -y- _
Owner's Address •
Is tbh putout In oe*jeuetloo with,bedding wok? Yes Er No El (Chick Appropriate Host)
Purpose of Su ei* I'??h2Q qe f fiddly
Aothorkatirm No.
Its;isMt thorwhoe►
Amps / Volts Overk eed 0 Vadprd 0 No.of Meters
.,..�. ... •
liegjiggio Amps / Volts Overhand 0 ..-,...,.
NumberofFodor*cad Ampaehty No.of Mshne ,_„�„�
� potion slot Nature of Proposed I Works I _ <
�^ e o z¢S
Ul.( f, ,r .i s 6,9 C mp efOoshikeseetlii.eigir loll imbed by ON lwr al'Wiles,
No.of Roma t sires j No.of (Peddle)Fps X0,o
/AtoCt} Al
No,of Lominalre Oudot No,of Hot Tabs G.NrsAtors KVA
No.of Lumblaires imam*tool Ahoy. 0 love. 0 ttl.ohmerekiey Linnet
No.of
No,of Oil Sernors FIRE ALARMS Na of Zones 1
No,of Switches ,No.of Gas Bo nor* a .. �""}" ; .*
' t"t� l�. a�iA.
No.of RoweNa of Air Loud.
No.o1'Aie ,s
No.of Wee* 71 : t e 'o
Nlo.of L�Mb ..
Sp*es/Asaa htaetts5 KW Load i .:, ." 0 shier
No.
of Dryers ILoetiap Applhss �r uoa ..
Kw
No. d i ,� a' j, 'i< :
11j" r�smosempr ladetahts No.of Moton Total ' ` ";� '
O THERt ►7�► rw* .a ` . t
Bedewed Valve of os►!Work: �a'Od '`ip .Dash tokfite esal'*kW ltd�►sl or as meshed by this! .oll ,s.
WOrIt to : .�.... (When required by lltlotla�el Iwllay)
INSURANCE �ti i�3 Unless waived by�enequested in s000rthmee with tt0 the IOC 1� completion.
the Howse provides proof of liability Maroc*including"compload*petition" ***kW work may Issue The
undersigned osrtitles t such cov r is In loco,and hasIts s l seguhnttstrt, Thee
CHECK ONE: INSURANCE [ia BOND CI OTHER 0 fot"suwrtr to the permit!suing Aloe.
I crrr ►►eater the polio essi�teipsy ,',m Ors tsl +es Mir sps//eswiar is owe,raast
FIAMNAMErCan. Cod Electrical
LIC.NO.t
LImesoot 1 it>< M 9 r 9 y tastie '""' `. °16'4"2`i d►...
agntkabie,ore""swore"In the hem*.nnrber lime) ''"" LtC.NO.t
Addwest .O �i ss 1594 # !I Q 0 Milli MA Q 2(i 4 E ft TeL No. .+:.?i�?r...—-;
*Per M.O.L.o. 147,s,5141,sou ty work requires Department of Public Ak.T41.Ned
VIIANCE WALVER, I an aware that the Lio s does not hew the liability Inst anoe
OWN
�*Malatw. By my si p us below,I hereby waive this requirem nst. i Am `
3ti
Sisaah►n Telephone No. PERWT FEE:$ 5 b•"
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