HomeMy WebLinkAboutBLDE-23-005875 Commonwealth of Official Use Only
:i�` Massachusetts
Permit No. BLDE-23-005875
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:4/24/2023
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) 248 CAMP ST UNIT U4
Owner or Tenant MCHUGH MADELYN S Telephone No.
Owner's Address 248 CAMP STREET U-4,WEST YARMOUTH, MA 02673
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 . f M rs
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install kick space heater&replace bathroo
0
Completion of the followin 4,7 ,ai ctor of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Notal
o.of s 4•• _4 KVA
No.of Luminaire Outlets No.of Hot Tubs Generators b 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
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ 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: NEIL SCHOENER
Licensee: Neil Schoener Signature LIC.NO.: 13949
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:44 TRADERS LN,W YARMOUTH MA 026733333 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
Commonwealth of Massachusetts permit No.:
23-S 75
I=lit= Department of Fire Services Occupancy and Fee Checked:
t-a 7i- , BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date: Al-2/- 202-3
To the Inspector of Wires:By this application,( the undersigned lives notices of his or her intention to perform the electrical wcirk described below.
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Location(Street&Number): 02 K g r'VY 0, sr- U A iT.¢ Unit No.: (../
Owner or Tenant: fY)4 L)e J Yn /Ilr'h 1.3 h Email:
Owner's Address: one No.:
Is this permit in conjunctir with a building permit?(Check appropriate box)Yes No❑Permit No.:
Purpose of Building: .477/ /e eflovezz Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps_/_Volts Overhead❑ Underground❑ No.of'Meters:_
.. Description of Proposed Electrical Installation: //ISZ'a'/ dee F eC 7 e /4Ce/!!trerr,.- aie ge
A.ttolace ne ir- 6,4-/X fife/
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:ln-Gmd.❑ Above-Gmd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Bunters: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 No,of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrij al Work: de/�7Q (When required by municipal policy)
Date Work to Start: q�6//20 L3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: it)
e t L J zrCl o?4 e/ A-I❑or C-1❑LIC.No.:
Master/Systems Licensee: 4/3 91 Q LIC.No.:
Journeyman Licensee: 6 o2 71
'l/ LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: // T/ZAt04QS (i✓ 4/{s r '/a HnOfi/
Email: Aet I eelute r� co4w sr'c/tTT TelephoneNo.: S-riOr-774—/fS7
I certiiee ins an penalties of perjury,that the information on this application is true and complete
Licensee: 4,-(---_-
t,-e _ Print Name:_/)e t / SC/iO t-I t Cell.No.: .W-7>`-or?
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
. provides proof of liability including"corn ted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of a to the permit issuing office.
CHECK ONE: INSURANCE BOND El OTHER El ie
Specify:
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: Tel.No.:
Signature: Email.: