HomeMy WebLinkAboutBLDE-23-004506 Commonwealth of Official Use Only
lPMassachusetts Permit No. BLDE-23-004506 � 1
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:2/14/2023
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) 66&68 ABBOTT RD
Owner or Tenant DAVENPORT DEWITT TR Telephone No.
Owner's Address DAVENPORT REALTY TRUST, 20 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664
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: Replace overhead service conductors.
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
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat Pump Number _ Tons KW No.of Self-Contained
No.of Waste Disposers
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: Lance A Macenerney
Licensee: Lance A Macenerney Signature LIC.NO.: 11149
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 126A MID TECH DR,W YARMOUTH MA 026732560 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: $80.00
S t•-( qc-(--z-(4 ( .
Commonwealth o/!/ladsachusett9 Official Use Only_
It.' f Permit No.
Ct g 2epartment o f. ire Serviced
.' s Occupancy and Fee Checked
,4`-, 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 CMR 12.00
.
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 14(a3
City or Town of: y&rf1'r1pt.1, 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) (pia-ee, abbott Rd.
Owner or Tenant bit vein pa 4 -Rec)J4. p i y Telephone No.
Owner's Address /1
Is this permit in conjunction with a building permit? Yes n No I I (Check Appropriate Box)
Purpose of Building Utility Authorization No.
^
Existing Service Amps I Volts Overhead Undgrd I 1 No. of Meters
New Service Amps / Volts Overhead n Undgrd I I No. of Meters
Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ICL°.p(Qei' O(erkeaA. SecrfGi C`pAd.(,CA-ors
and in4A1 ntsAJ eye hid+.
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires No.of Ceil:Sus No.of Total
p.(Paddle)Fans 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
Initiating Devices
No.of Ranges No.of Air Cond. Tons No. of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: - Detection/Alerting Devices
:,No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water s KW Teo.of No.of Data Wiring:
HeaterSigns _ 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 Start: Inspections 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 El OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.FIRM NAME: p-,,,tier P Et dei c e_orrNparNy LIC.NO.: All I Lf
Licensee: Lan ,,e ifY\0.CEherrN,e� Signature LIC.NO.:
(If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 61))77S-OO.
Address: j 2(a A lend Ter.-4\br V\1. G1 irr'Y1� x#k p t 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)El owner ❑owner's agent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE: $ 7 0 e