HomeMy WebLinkAboutBLDE-23-000559 - ... Commonwealth of Official Use Only
?At,. Massachusetts Permit No. BLDE-23-000559
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:8/3/2022
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) 7 LUMBERJACK TRAIL
Owner or Tenant BECKLOFF ADAM P Telephone No.
Owner's Address BECKLOFF TERRY A, 7 LUMBERJACK TRAIL, WEST YARMOUTH, MA 02673
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: Power to shed&miscellaneous other work 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
Initiatine 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 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: WELLINGTON R SOARES
Licensee: Wellington R Soares Signature LIC.NO.: 21075
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 110 BREEDS HILL RD,UNIT 5,HYANNIS MA 026011864 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: $75.00
Commonwealth ei flaaaacLsoiit Official Use Only
`f' 7-3 _�C$59
B ? ccyy�� (n� Permit No.
I i r �Uslvarf`msni o�.}u,a Ja•vacse
*' 1( v BOARD OF FIRE PREVENTION REGULATIONS
( OccupancyRev. 1/07] an(ldeave Fee Checblank)ked
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code NEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -I-J0;-
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) .- IA(4'EFyj jri, i'R-AIL
Owner or Tenant 1e VIr y Bef. iat Telephone No.
Owner's Address 1
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: e , 7 -}-d y S U I e Q(J f x 11��� �� hq. l
., 4:krde., * "t\7JG C�Y6 yy11SSiV1 1'D7'�i vow rtnu Y-C-S JY) Ff=ci �'�c:V _
KIvts�swl ttl G 11 I,
N+1 Completion of thefollowingtable m be waived by the Infector of Wft s.
No.of Recessed Luminaires No.of Ceil.-Soap.(Paddle)Fans No.off Total r—
Transformers KVA
` 1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA r,
�t.` 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 INo.of Zones
No.of Switches No.of Gas Burners 'WO.of Detection and
11.1 No.of Ranges No.Oi Air Cond. Total Initiating Devices
Tons No,of Alerting Devices
No.of Waste Disposers Heat Pump lumber. T one KW 'No.of Self-Contained
Totals: """ Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local Mi
❑ Connectiounicpal n ❑ �a
No.of Dryers Heating Appliances KWSecurity Systems:*
No.of Water No.of Devices or Equivalent
Heaters 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 Stan: `@,r:;) 4.L Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COV RAGE: Unless waived by the owner,no permit for the performance of electrical work may
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equi ale to These
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE En BOND 0 OTHER ❑ (Specify:)
I certify,under*pains and pen of p u ,that the informgtlon on this application is true and complete.
�e
FIRM NAME: A, I(f Y 'U1(j J(:1 i ilet,i V I C lid i I of LIC.NO.: t(1 T7S 4
Licensee: i I V Signature L . LIC.NO.: / 6 6
(If applicable,enter"exempt'•in I 1' ense umber line). Bus.Tel.No.• cr r Address: IlO bi't'.t'4.S I-I1it 'G.)CoC 1,),V:IT tiyk is 1'j7 ,�c' Alt.Tel.No.: r*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 by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$