HomeMy WebLinkAboutBLDE-23-15519 yr Commonwealth of OOfliciialUseOnly q
. , tit Massachusetts I Permit No. BLDE-23-0 I SS /
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.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:12/7/2022
City or Town of: YARMOUTH To the Inspector of Wirer
By this application the undersigned gives notice of his or her mtenhon to perform the electrical work described below.
Location(Street&Number) 74 WHITE CEDAR RD
Owner or Tenant PHIPPS CAPE COD LLC Telephone No.
Owner's Address C/O BESSEMER TRUST,100 WOODBRIDGE CTR DR STE 302,WOODBRIDGE,NJ 07095
Is this permit in conjunction with a building permit? Yes❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters
New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity GJ d 16? 7j2 3 t ?1{
Location and Nature of Proposed Electrical Work: New residence. sir y{J tVerwsislie i,-135"riAI
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 Emerge fighting,
grnd. grad. Battery Units �,�(/
No.of Receptacle Outlets No.of Oil Burners FIRE :..11 o.0l"+7one f
No.of Switches No.of Gas Burners No.o V's cttb�and ��
Initiatinebevices
No.of Ranges No.of Air Cond. Totalo No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained S
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 CoMunicectioipal n 0 r:
nn _
No.of Dryers Heating Appliances KW Security Systems:* O
_No.of Devices or Eunivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Stens ,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: Christopher A Crispin
Licensee: Christopher A Crispin Signature LIC.NO.: 52768
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:156 RED BROOK RD,PLYMOUTH MA 023605700 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:$180.00
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RECEIVED
DEC "�'h: C [th Official Use Only
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'�� ,B`,��:wJ c� ec�/ �7 Permit No.r/ j'� �c�
BUILDING a.,..:al..r; ',ENT
1JrPc+r>t+nrnE o� firs Serviced
By -- t I, 4'__.. Occupancy and Fee Checked
A :•ARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
0 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Maec2rhusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I I(v/a?
—J City or Town of: ''1armd�.}VN To the Inspector of Wires:
(s ') By this application the undersigned gives liVr her intention to perform the electrical work described below.
J Location(Street&Number) 17i. Q av' �Ot n r }�ct
Owner or Tenant Sf r y TIN S t Telephone No. �g �7 7 �{sdU
v Owner's Address 37 7 7 1"a r.); m; Tv.r t 1
N Is this permit in conjunction with a building permit? Yes cif No ❑ (Check Appropriate Box)
v Purpose of Building (eS Ideht 1 a ) Utility Authorization No.
. s Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
..-! New Service aC0 Amps 1.0 /aM0 Volts Overhead❑ Undgrd EZ No.of Meters f
N. Number of Feeders and Ampacity
C, Location and Nature of Proposed Electrical Work: 1,01101t h0U A 1,r f ) of w C ern S f r vG Ki O 0
v) Completion of the following table may be waived by the Inspector of Wires.
Total
i.1 No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No
f
Transformers KVA
Q No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimmingpool Above In- No.of Emergency Lighting
grnd. ❑ grnd. ❑ Battery Units
J No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
It, No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number To KW No.of Self-Contained
Totals: " ns Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Monnectiounicipaln 0 Other
C
No.of Dryers Heating Appliances gWrity Systems:*
No.of Devices or Equivalent _
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin :
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: '3 °d° (When required by municipal policy.)
Work to Start: I aZ)(0 pc,1 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 121 BOND ❑ OTHER ❑ (Specify:)
I cern:v,under the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: (,-,kr; s Cr,s ' n f 12C1'tr/(.+a t'I LIC.NO.:
Licensee: C h r i c ip oc e C r,5 j r) Signature -� LIC.NO.: 5 o 7 28 f
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.• 10 I 1 .21 7 to`I 3
Address: te Tv-et 4-of) ' J j 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
Signature Telephone No. PERMIT FEE:$ f k0,00