HomeMy WebLinkAboutBLDE-23-004876 Commonwealth of Official Use Only
of 41 Massachusetts Permit No. BLDE-23-004876
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:3/6/2023
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) 17 STONEY HILL DR
Owner or Tenant KEVIN FORSYTH 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 100 Amps Volts Overhead ❑ 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: Re-install SEU entrance cable&replace Point of attachment.
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 ❑ 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: Michael D Hollister
Licensee: Michael D Hollister Signature LIC.NO.: 10071
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:85 N DENNIS RD,S YARMOUTH MA 026641017 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:$50.00
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'• APPLICATION FOR PERMIT TO PERT- LECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 C R 12.
City or Town of: YARMOUTH Date: 3 6 2�
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): { 7 j- 7 /—f( /,1(/! !�� Unit No.:
Owner or Tenant: rcv,,, j^o lec"yr-y- Email:
Owner's Address: Phone No.: SDf 3 9 et 3.3 (off
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No 0 Permit No.:
Purpose of Building: (Z 6'S/V t t/Z Utility Authorization No.: 6-j/l cc/C.10971( f
Existing Service: l D f) Amps /7a/f/y Volts Overhead g( Underground❑ No.of Meters:
New Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
, Description of Proposed Electrical Installation: ',�' f A'S r ► -GG_.. S -Vic :A/1; 4-n/CC
46c(-= g lc1L:p-cc r,Y 7— O p rrp 1-iiri 477---
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC.Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elect i al ork: 5 9 s� (When required by municipal policy)
Date Work to Start: ?(3/t"3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: e/G1-1 A' -L P 1O S7G 1L 6Le'Tee i' A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.: /00 7/— G
Journeyman Licensee: r'4 / !e__ L ' LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. qP--i.
S-LIC.No.:
Address: CO <" /A e aU 06 Nat//S e ci OtJ-11-4
Email: OA 116,6 14 oz_e -1ST-le-ELc e 7'r()G& / `/2/LTelephone No.: €U f 7 7 o C3 / "'
I certify,under <'e pains a p alties of perjury,that the information on this application is true and complete.
Licensee: j Print Name: y l ► /k.0 4�J L 'ic Cell.No.: 7 7 S ?i
INSURANC 0 VE : nless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability 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 ELBOND❑ OTHER El Specify: t;/AP/L t l rf r Ul/a d C
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law.By my signature below,I hereby waive this requirement.I am the:(Check one)Owner❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
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