HomeMy WebLinkAboutBLDE-22-000911 BLD. 7 Commonwealth of Official Use Only
11)% Massachusetts Permit No. BLDE-22-000911
�-.»0 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:8/17/2021
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) 481 BUCK ISLAND RD
Owner or Tenant BUCK ISLAND VILLAGE CONDOS Telephone No.
Owner's Address C/O BOARD OF TRUSTEES,481 BUCK ISLAND RD,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appro ►yl Box)
Purpose of Building Utility Authorization No. .r
Existing Service Amps Volts Overhead 0 Undgrd 0 . M ��f"
New Service Amps Volts Overhead 0 Undgrd 0 c•. ,f'"4- r3'�' l PN`
Number of Feeders and Ampacity 4 f / N, . i
Location and Nature of Proposed Electrical Work: Replacement metering equipmen ` �' j.
,reCompletion of the following table ma ived e414'
t. of Wires.
;No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. f
Transformers V/t)
No.of Luminaire OutletsNo.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
Initiatine Devices
No.of Ranges No.of Air Cond. Tons Tot No.of Alerting Devices
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 Siens No.of Devices or Equivalent
No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
y g 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 ❑ 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: JOHN H BREWER
Licensee: John H Brewer Signature LIC.NO.: 14092
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:205 CEDAR ST,W BARNSTABLE MA 026681324 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) ❑ owner 0 owner's agent.
Owner/Agent Signature Telephone No. I PERMIT FEE: $80.00 I
Official Use Only
Commonwealth O',wBBCilIJSef'S Psrmitl�lo.
t `I
t Department of Fire Services -M/,---09.\1 (
of and Fee Checked -.
�Lr1_= RI* �I£eY. iIUIJb
r_ _ BOARD OF FIRE PREVENTION REGULATIONS
APPUUCATIII)N FOR PE,- , ,aTT TO PERFORM ELECTRICAL ';'CORK
All work to be performed in accordance with the Massachusetts Elee Data Cod �� l�ao
SE ((ME I
2.
(PLFMPALNTrNIN OR E ALLO.RWATIOAO To the I actor ,,,.y:
City or Town of:
By
cS
application the undersigned gives notice of As or her intention to perform the electrical work described below.
Location this 'tip- / U CI A5 f1�--
(Street&Number}: V.l.�� �' 'Q-�� IepTQorae No.Owner or Tenant �, ?1.1C f 5 1
Owner's Address �i
0
�
is this this permit in conjunction with a building permit? Yes 0
No (Check Appropriate Box)
Utility Authorization No.
Purpose of Building /? 2LS/-ti p 0
�,3isfitig Service Amps
Volts Overhead 0 Undgrd No.of Mete s
New Service Amps
Vold Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity �%
Location and Nature of Pr osed ,sect C.. �.La Ct .j'7�' /
Completion of tlnefalloiPltr,Q table NM be waived�'the��of'H%ires
Pao.of Recessed Luminaires 1To.of Cell.-Snap.(Paddle)L+aas Transformers A
No.of I,umi-iaire Our` No.of Hot s
Generators KVA
Swimming Pool „r ud. ❑ grad. II Battery'Units
No.of Luminaires
No. -,ALARMS }No.of Zones
of Receptacle Ou ets No.of Oil Burners I Q.o bet m:6n and
No.of Gas Burners r,•;, :I,• Devices
No.of Switches -one
No.of Air Cond. Tons No.of Alertin.Vices
No.oaten - DntonlAle3 x,T r '3C
No.of Waste isliosers Totals: , u,
Space/Area_Reedn KW Local Coun�:ion El Other
No.oi°DisItfvashers nentin t�pplran � �=1 Securityoaf�cesor ,t
No.of s ryers �: �• I��" ;s!..
INo.or No.o t
No.of ester i Ballasts No.of Devices or p. }
Heaters Signs eteeammuatrs,aas V wew
No.Hydf omss§age Batittbs
No.of Motors Total W No.of Devices or Equivalent
OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires.
(When required by municipal policy.)
Estimated Value of Electrical Work: in accordance with MEC Rule 10,and upon completion.
Work to Start: InSpections to be requestedarmor for performance ;cal may issue unless
IN
� G Unless waived by the owner,no p eared for th i performance
or its substantial equivalent issu The
the licensee
("OVERAGE: "completed operation"coveragepermit issuingub office.
the provides proof of liability_insurance including • proof of same to the pe
undersigned certifies that such coverage is in force,and has exhibited
BOND 0 OTHER. g ESp =) awe and complete.
CHECIL ONE:INSURANCE is aPF cat C
P fy tinder die patios atzrt�reurtlfies o.f`'Perjrsry,F r�the itzfrr � C.1�C}.r�+Z9��
Lice NAME:John Brewer Electric A �-- t f �� L€C.NO..AI
4092
Si„ t� Bus.Tel-No.:
&applicableLicensee: enter pt„in dre license niter line.} ___----
Address: c1. .1 Tat i�lo»50&3b7-Q167
'its ar- fly./. ! -.. : . '3r • Lic.NO.
i3 c.147,s. Department of Public Safety"S"License: f
work requiresmstuance coverage normally
'Ter - c.147, �NCE WAIVER:
ie Licensee does not have the liability owner's n rm agent
required
OWNER'S IN ►�idti R:I am hereby waivee 3tat I air the(check one) finer
� .By below,I this requirement�1 0 3 VT PERMIT
Signature
AA.A/1 Telephone No= (' •
Signature Cif/ j431q 1/1/ e `V4' ` _crar