HomeMy WebLinkAboutBLDE-23-003288 Commonwealth of Official Use only
Massachusetts Permit No. BLDE-23-003288
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:12/13/2022
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) 11 PARK AVE
Owner or Tenant LEAHY JOHN J Telephone No.
Owner's Address LEAHY MARTHA A, 5 TAFT ST, NASHUA, NH 03060-5020
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: Septic pump&alarm
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
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 1
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 Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 1 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: REILLY ELECTRICAL CONTRACTORS
Licensee: Sean Reilly Signature LIC.NO.: 22960
(II applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 14 Norfolk Avenue, Eastson MA 02375 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: $50.00
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Commonwealth o/Massachusetts Official Use Only
=* cc� Permit No.��-3 -3-Zf9e.
-- .2 epartment o f lire Services
__1_�- Occupancy and Fee Checked
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: 12/13/2022
City or Town of: West 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) 11 Park Avenue
Owner or Tenant Martha Leahy Telephone No.
Owner's Address 5 Taft Street- Nashua, NH 03060
Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box)
Purpose of Building Single-Family Dwelling Utility Authorization No. n/a
Existing Service 100 Amps 120/240 Volts Overhead V Undgrd ❑ No.of Meters 1
New Service Amps / Volts Overhead n Undgrd I I No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Power and control wiring for new seprice pump w/alarm.
Completion of the followingtable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp•(Paddle)Fans Tr 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
of
No.of Switches No.of Gas Burners No. Initiatinnggon Dete and
In 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 Connection
No.of DryersHeating Appliances h«� Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications N . fDeiceorWiring:
y g No.of Devices Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $800.00 (When required by municipal policy.)
Work to Start: 12/13/2022 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 ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information n this plication is true and complete
FIRM NAME: Reilly Electrical Contractors, Inc. LIC.NO.: 556 Al
Licensee: Sean Michael Reilly Signature LIC.NO.: 22960-A
(If applicable,enter "exempt"in the license number line) Bus.Tel.No..508-394-3211
Address: 14 Norfolk Avenue,Easton,MA 02375 Alt.Tel.No.:508-400-8936
*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 ['owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: $