HomeMy WebLinkAboutBLDE-23-005922 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-005922
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:4/25/2023
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) 117 CENTER ST
Owner or Tenant ANN CAVANAUGH Telephone No.
Owner's Address THE ANN CAVANAGH-STEIN IRR TRUST, 117 CENTER ST,YARMOUTH PORT, MA 02675
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: Wiring for new circuit tor laundry.
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 0 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 ❑ Municipal 0 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 ❑ 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: PAUL M RYDER
Licensee: Paul M Ryder Signature LIC.NO.: 39762
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:210 WESTWIND CIR, OSTERVILLE MA 026551366 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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�J Permit No.: �- -'t 2
�'= = Department of Fire Services Occupancy and Fee Checked:
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B RD OF FIRE PREVENTION REGULATIONS [Rev. I/2023]
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BUiLa ,a,i L 1'
..ILICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 CMR 12.00
City or Town of: YARMOUTH • Date: &( _ zs- - 2-3
To the Inspector of Wires:By this application,the undersigne gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): // 7 ( 1... S./r
Owner or Tenant: ^` oar Unit No.:
/�n A. ✓fr"c..✓, Email:
Owner's Address: SAS j No.: �1 Z -
!-�� c7 0
Is this permit in conjunction wi h a building permit?(Check appropriate box)Yes 0 Phone Permit No.: `
Purpose of Building: I r '�
Utility Authorization No.:
Existing Service: l U u Amps Lei/ Atolls Overhead
New Service: / Z Y AV ®' Underground❑ No. of Meters:
Amps / Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: 2. (1 Cc.^`
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches:
No.Luminaires: No.of Recessed Luminaires: Generator KW Rating: Type:.
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.0 Hot-Tub
0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System
No.Air Conditioners: 0 No.of Devices:
Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: SecurityS
Solar PV KW DC Rating: Solar PV KW AC Rating: System
0 No.of Devices:
No.of Modules: Roof-Mount 0 Ground-Mount No.of Electric Vehicle Supply Equipment:
OTHER: ❑ Level 1 0 Level 2 0 Level 3 0 Rating:
Attach additional detail if desired,or as
required by the Inspector of Wires.
Estimated Value of Electrical Work: O1
Date Work to Start: - 1- U (When required by municipal policy)
`/ -23 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: p/Z- t he c--7c-r c.." LLB
A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: /-✓/ /j'O CA_
LIC.No.: Z
Journeyman Licensee: /CT [
LIC.No.:-`j ( / U
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: ________A___ ______i x A
Email: 1-�--_ ^vi/( 7'�
i N �.€ 'r 2��..�Ea! ........./ . H �.� Telephone No.:f e? L Bo 66 2/
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: Av / It e- Print Name: if V / / y1 e.r-
INSURANC COVERAG : Unless waived by the owner,tfo permit for the performance of electricalCell.Noork may s Z9 U _‘63./
sue 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 ❑
BOND❑ OTHER -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not h�the liabili �fnsuranc
required by law.By my signature below,I hereby waive this requirement.I am the: (Check one)Owner L] Owner's agent normally coverage ❑
Owner/Agent:
Tel.No.:
Signature:
Email.: