HomeMy WebLinkAboutBLDE-23-004094 Commonwealth of Official Use Only
fL. ,4 Massachusetts Permit No. BLDE-23-004094
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) 923 ROUTE 6A UNIT 0
Owner or Tenant CHAPTER TWO LLC Telephone No.
Owner's Address C/O IVANA LIEBERT, PO BOX 206,YARMOUTH PORT, MA 02675
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 GFCI near bar sink. (BUILDING 4 UNIT 0)
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 1 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
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Eouivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Eouivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Eouivalent
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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: CORY J WALKER
Licensee: CORY J WALKER Signature LIC.NO.: 54207
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 110 Sheffield Rd, Brewster MA 026312860 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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` f o� s Permit No.
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'� /`? tJB A D OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
i ___ [Rev. 1l07J (leave blank)
B U,Lo,N T T ION 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 INFO TION) cr Date: \ �-Z -7D
ByCity or Town of: C\\1\'\'\CA2, 1'Y 1 1 — To the Inspector of Wires:
this application the undersigned giy�es notice of his or her intention to perform the electrical work
described low.
Location(Street&Number) �� (L fl j `,l \C�\l 1 y 1 \ .
Owner or Tenant C \ :kg �\A; C✓ J Telephone No. S 4S-Lf -- 13 i 1
Owner's Address �; S C C L C\*%a�" \ Qv NNA .1 i t �����`i1,X C�YIC��SC�
ll�`7
Is this permit in conjunction with a buildi�g permit? Yes ID No (Check A
NoJ
ppropriate Box)
Purpose of Building '7� ;�V<`.-,C\v1C S('11 i\\(7Utility Authorization No.
Existing Service Amps / Volts ) Overhead ❑ Undgrd g 0 No. of Meters
New Service Amps / Volts Overhead❑ Undgrd g 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ��J)- \n �' 1()5 C\ C�fi 1 V'2Ck\I `t I
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires fr'io.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
grad. grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners No.of Detection and )
Initiating Devices
No.of Ranges No.of Air Cond. Tota .
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number}Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters ' No.of Data Wiring;
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total gp 'Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Attach additional detail ifdeer , I
Estimated Value of Electf 1�cal Work: 1 t ed,, or as required by the Inspector of Wires.
Work to Start: ' 1 7 (When required by municipal policy.)
12 .'> i 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 PS 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:
LIC.NO.: ��.. + -Licensee:
Cc`' J t ( Signature A.-.v(Ifapplicable,enter x, �p t"i e li se n r line.) LIC.NO.:
Address: t - 41� o' s ---(4,: Bus.Tel.No.. -• l - 51
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety"S"License: Att.L c.Tl.Noo..: 5 :- � �•-�1
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature owner •
below,I hereby waive this requirement. I am the(check one ■
Owner/Agentowner's ,tent.
Signature Telephone No.p PERMIT FEE: $ L