HomeMy WebLinkAboutBLDE-23-353 BLD 9 or
� �� ���� Commonwealth of
' Official Use Only
�+-,' Massachusetts çcuancy
mit No. BLDE-23-005478
'�' BOARD OF FIRE PREVENTION
REGULATIONS p and Fee Checked
.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)
ate:
City or Town of: YARMOUTH DTo the I3/2023
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
r of Wires:
Location(Street&Number) 481 BUCK ISLAND RD
Owner or Tenant BUCK ISLAND VILLAGE CONDOS
Teephone 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?
Purpose of Building Yes 0 No 0 (Check Appropriate Box) /
Existing Service Utility Authorization No. 1246403 1 ?-- (c? °3
Amps Volts Overhead ❑ Undgrd 0
gNo.of Meters
New Service
Amps Volts Overhead 0 Undgrd of Feeders and Ampacity 0 No.of Meters
Location and Nature of Proposed Electrical Work: Replace secondaryto xfmr&re lace meter stack on building#9
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
otal
Transformers K
No.of Luminaire Outlets No.of Hot Tubs KVVAA
Generators KVA
No.of Luminaires SwimmingPool Above In-
rnd. ❑ :rnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets No. Batter Units
of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners
No.of Detection and
No.of Ranges Initiatin' Devices
No.of Air Cond. Total
No.of Waste Disposers HeatNumber Tons
PumpNo.of Alerting Devices
Totals: KW No.of Self-Contained
No.of Dishwashers _-Dete tion Alertin' Devices
Space/Area Heating KW Local ❑ Municipal
No.of Dryers onnection ❑ Other:
Heating Appliances KW Security Systems:*
No.of Water KW No.of No.of Devices or E.uivalent
HeatersNo.of Ballasts Data Wiring:
He Hydromassage Bathtubs No.of Devices or E I uivalent
No. No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or E I uivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: (When required by municipal policy.)
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: MATTHEW P DENNEN
Licensee: Matthew P Dennen
Liapplicable,enter"exempt"in the license number line.) Signature
LIC.
PO BOX 88, BUZZARDS BAY MA 025320088 Bus.Teell..No.:NO.: 21609
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/Agent ) 0 owner ❑ owner's agent.
Signature
Telephone No.
PERMIT FEE: $160.00
I 4 e
t9-047 4 iii.1( -3 .. .
te_ tt (34_3 fir. 0,,
43/7.3 if_____