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HomeMy WebLinkAboutBLDE-23-001585 Commonwealth of Official Use Only
• Massachusetts Permit No. BLDE-23-001585
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:9/26/2022
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) 89 SWAN LAKE RD
Owner or Tenant MARCY LEVINGTON Telephone No.
Owner's Address 89 SWAN LAKE RD,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 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Miscellaneous work per attached.
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. Ton l No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons 1 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 Sins 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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: SAGAMORE ELECTRIC
Licensee: Stephen Davis Signature LIC.NO.: 22878
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 117 Old Plymouth Road, Sagamore Beach MA 02562 Alt.Tel.No.: 7743137154
*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
5,-1 ,� hug_ �� � � ' V 'v �ruuea l/�o a�aac efts Official Use Only/?j ��m 11 c� Permit No.
=gjl_ e,•riment o f giro Services
-r_ S p ,2 6 9Q2_, 2 Occupancy and Fee Checked
OARD OF FIRE PREVENTION REGULATIONS Rev. 1/07]
,.—.4 (leave blank)
' Vil DINS; DEPARTMENT
AF?PLU a • ► • - 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: 9/25/22
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) 89 Swan Lake Rd, West Yarmouth
Owner or Tenant Marcy Levington Telephone No. (617) 283-2860
Owner's Address 89 Swan Lake Rd, West Yarmouth
Is this permit in conjunction with a building permit? Yes ❑ No DC (Check Appropriate Box)
Purpose of Building Residence Utility Authorization No.
Existing Service 100 Amps 120r240 Volts Overhead ® Undgrd❑ No.of Meters 1
New Service Amps / Volts Overhead ❑ Undgrd ri No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Service Change, adding wafer lighting in bedrooms,
adding plugs to bedrooms, smokes to bedrooms.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.ofCeil: P Sus . Tf Total(Paddle)Fans Tr
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergency Lighting
No.of Luminaires Swimming Pool grad. ❑ grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No. Initiatingon Detectionand
Devices
Tot
No.of Ranges No.of Air Cond. 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 J
No.of Dryers Heating Appliances KW Security Systems:*
�Y No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No. H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring
Y g 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: 9/25/22 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 on this application is true and complete.
FIRM NAME: Sagamore Electric LIC.NO.:22878-A
Licensee: Stephen Davis Signature 44a4,----- LIC. NO.: 53534-B
(If applicable,enter "exem t"in the license number line.) Bus.Tel.No.; (774)313-7154
Address: 117 Old Plymouth Rd 1 B Sagamore Beach, MA 02562 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)❑ owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ 50.00
Signature Telephone No.
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