HomeMy WebLinkAboutBLDE-23-001320 -it, Commonwealth of official use only
h_. Massachusetts Permit No. BLDE-23-001320
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:9/12/2022
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) 23 WINDSWEPT PATH
Owner or Tenant EDWARD WILCHYNSKI 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 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: Install generator.
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 1 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 ❑ 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 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Nicholas McEloy Signature LIC.NO.: 22642
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:31 Captain Carleton Road, Cotuit Ma 02635 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
ACommonwealth of Maoac/.ueetta Official Use Only
)! ' !t � .. 'j c'
ccy�,, e� Permit No.
t. t{ 5 2epartment o j..}iee Service9
Occupancy and Fee Checked
1 *��:
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 R 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 & 01 A
City or Town of: Clic at 0(47/h To the Inspecto of ices:
By this application the undersigned gives tice of his or her intention to perform the e ectrical work escribed below.
Location(Street&Number) ,a 3 (it'( i “"" I 1, r j C4
Owner or Tenant Fd tti gird (. jI I('!��I_ lIl SW Telephone No7 J. f/d- d.5."*".c
Owner's Address
Is this permit in conjuion wit a bui ing permit? Yes ❑ No e. (Check Appropriate Box)
n�
Purpose of Building es ' eiell (A. L Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: - i I.S 4 H wi3O k h 0 I114 c 2eet+e r4J the.
Completion of the followingtable 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- 0 No.of i mergency Lighting
grnd. grad. 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
Tot
No.of Ranges No.of Air Cond. Tons 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 Municipal
❑ Connection ❑ Other
No.of Dryers Heating Appliances KW security Systems:*
No.of Water No.of Devices or Equivalent
No.of No.of
Heaters KW Signs Ballasts Data Wiring:
No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
at Attach additional detail((desired,or as required by the Inspector of Wires.
Estimated Value of El ctrical Work: 5000 (When required by municipal policy.)
Work to Start: 9ly Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COV RAG : 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 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and comple
FIRM NAME: Cape Cod Electrical LIC.NO.:
2_964?_A
Licensee: Nick M c E 1 r o v Signature /� — LIC.NO.:670 Al (Business)
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508-566-4489
Address: 381 Old Falmouth Rd.Ste 32 Marstons Mills,MA 02648 Alt.Tel.No.:
*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 [j owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ .,0.06
Email: Office@capecodelectrician.com