HomeMy WebLinkAboutBLDE-23-004106 Commonwealth of BLDE-23-004106Official Use Only
eE• 1 Massachusetts
:tgliPermit No.
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:1/25/2023
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) GREENOUGHS POND
Owner or Tenant CAPE COD COUNCIL OF B S A Telephone No.
Owner's Address 247 WILLOW ST, YARMOUTH PORT, MA 02675-1744
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 300 Amps Volts Overhead El Undgrd 0 No.of Meters
New Service 300 Amps Volts Overhead 0 Undgrd I l No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Change 0/H to U/G(PANEL BY ENTRANCE)
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. Ton l 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 ❑ 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 Siens 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: MARK L AVERY
Licensee: Mark L Avery Signature LIC.NO.: 13272
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 77 AGNES RD, SOUTH DENNIS MA 026602814 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
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_`yi_ Occupancy and Fee Checked
" — :TI1 _QE,FA NE NTION REGULATIONS [Rev. 1/07] (leave blank)
By:
APPLICATION - RMIT 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: 1/23/2023
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)227 Pine St Yarmouth Port,MA 02675-"Panel by main entrance"
Owner or Tenant Cape Cod&Islands Council,Boy Scouts of America Telephone No. (508)362-4322
Owner's Address 247 Willow St,Yarmouth Port,MA 02675
Is this permit in conjunction with a building permit? Yes ❑ No ❑■ (Check Appropriate Box)
Purpose of Building Meeting/office Utility Authorization No. pending
Existing Service 300 Amps 120 / 240 Volts Overhead n Undgrd❑ No.of Meters 1
New Service 300 Amps 120 / 240 Volts Overhead❑ Undgrd ❑■ No.of Meters 1
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Change electrical service from overhead to underground,
new feed off padmount transformer
Completion of the followin&table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf T
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 Detection and
No.of Switches No.of Gas Burners Initiating Devices
No.of Ranges No.of Air Cond. Total
g Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other
p uri Cyonnection
No.of Dryers Heating Appliances KW Sec Not of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H
Y gNo.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:2/15/2023 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 0 BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete
FIRM NAME: Mark L.Avery .NO.:
Licensee: Mark L.Avery Signature LIC.NO.:13272
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:5°8-898-8890
Address: 77 Agnes Road,S.Dennis MA 02660 Alt.Tel.No.:774-994-0626
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SS-002294
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 PERMIT FEE: $80.00
Signature Telephone No.