HomeMy WebLinkAboutBLDE-23-004878 Commonwealth of Official Use Only
ft. , Massachusetts Permit No. BLDE-23-004878
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:3/6/2023
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) 9 EIDER ST
Owner or Tenant COVELL RICHARD B Telephone No.
Owner's Address 9 EIDER ST,YARMOUTH PORT, MA 02675
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No. .,
Existing Service Amps Volts Overhead 0 Undgrd 0 No.tif.Meters -. 1,/
New Service Amps Volts Overhead 0 Undgrd 0 bib.of Meters ' rt
Number of Feeders and Ampacity , {.�
Location and Nature of Proposed Electrical Work: Replacement furnace
Completion of the following table may be waived,,by the Inspector of Wltgs.
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 1 No.of Gas Burners 1 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 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: A J PULLEY
Licensee: A J Pulley Signature LIC.NO.: 21843
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:289 QUAKER MEETING HOUSE,RD,E SANDWICH MA 025371366 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 Official Use Only
—_. Permit No.:l%1-1—&-{ 6 716
f_ _= Department of Fire Services Occupancy and Fee Checked:
,='1"- - BOARD OF FIRE PREVENTION REGULATIONS vtiv [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: / ytn,%ourta Date: 3f3/z.
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 9 E'1 Dot Sr. Unit No.:
. , . Owner or Tenant: Wtv-v&EVA) CO 1 1-x- Email:
Owner's Address: 54. Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No /RPermit No.:
Purpose of Building: (4-%i Dr'TrrAt.- b....rEu►.JG Utility Authorization No.:
C Vit. Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: bt1„2>c Rc A.Atz''mitv.►r FL/A-NW;
Completion of the following le may be waived bbtthe Inspector of Wires.
No.of Receptable Outlets: No.of Switches) /1 Generator KW Rating: Type:
No.Luminaires: No.o ecessed 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❑ No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Gmd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: 0 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 ❑ 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 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elec tqal Work: (When required by municipal policy)
Date Work to Start: 3/3/23 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: I.-1A.a.t_ p,L Lb. A-1 ❑or C-1 0 LIC.No.:
Master/Systems Licensee: A3 Pv.A.Q1 LIC.No.: /}Z))4/3
Journeyman Licensee: h / LIC.No.: /0 22J a
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: P.Q. 31;ye 1-4O( Stwr,{ >k..),s, NAA . OL.L.L,0
Email: ELEC-faxi— 14.4-ta Dui_GA-S AN i Fttzr•21 t_, COS Telephone No.: co r 3 4Y 33.31 1 An 0
I certify,under rains and penalties of perjury,that the information on this application is true and complete.
Licensee: ,// Print Name: A I ui.i. Cell.No.:
INSU "(COVERAGE:Unless waived by the owner,no permit for the peYformance of electrical work may issue unless the licensee
provides proof of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of e to the permit issuing office.
CHECK ONE: INSURANCE[BOND❑ OTHER❑ 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.: