HomeMy WebLinkAboutBLDE-23-004107Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-004107
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: 1 /25/2023
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) GREENOUGHS POND
Owner or Tenant CAPE COD COUNCIL OF B S A Telephone No.
Owner's Address 247 WILLOW ST, YARMOUTH PORT, MA 02675-1744
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service 200 Amps Volts Overhead 21 Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Basement room for amateur radio station. Bonding & grounding as required.
(MAUSHOP LODGE)
Cotttnlelion of the following table may he waived by the Inmortnr nPWir—
No. of Recessed Luminaires
No. of Ceil: Susp.(Paddle) Fans
No. of V
Transformers
Total
K A
No. of Luminaire Outlets
No. of Hot Tubs
Generators
KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. grad.
No. of Emergency Lighting
Battery Unit
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiatin2 Devices
No. of Ranges
No. of Air Cond.
Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
I Tons
I KW
No. of Self -Contained
Detection/Alertine Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑
Connection
Other:
No. of Dryers
Heating Appliances
KW
Security Systems:*
No. of Devices or E uivalent
No. of Water KW
Heaters
No. of No. of Ballasts
Siens
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or E uival nt
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 ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, under thepains andpenalties ofperjury, that tire information on this application is true and complete.
FIRM NAME: MARK L AVERY
Licensee: Mark L Avery Signature LIC. NO.: 13272
(Ifapplicable, enter "exempt" in the license number line) Bus. Tel. No.:
Address: 77 AGNES RD, SOUTH DENNIS MA 026602814 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) ❑ owner ❑ owner's agent.
Owner/Agent
Signature
"JJ
t-3C
Telephone No.
PERMIT FEE: $200.00
1srm D n1a�ac%uas Official Use Only
BAN WMT]w2 3 Zia „� o`� s�,.ic� Permit No.
Occupancy and Fee Checked
ENTION REGULATIONS [Rev. 1111] (leave blank)
By -
APPL ERMIT 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: 1 /23/2023
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) 227 Pine St Yarmouth Port, MA 02675 - "Maushop Lodge"
Owner or Tenant Cape Cod & Islands Council, Boy Scouts of America Telephone No. (508) 362-4322
Owner's Address 247 Willow St, Yarmouth Port, MA 02675
Is this permit in conjunction with a building permit? Yes ❑� No ❑ (Check Appropriate Box)
Purpose of Building Meeting/office Utility Authorization No. n/a
Existing Service 200 Amps 120 / 240 Volts Overhead 0 Undgrd ❑ No. of Meters 1
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Add wiring for new room in the basement for office space / Amateur Radio
station. Antennas run underground to poles outside building. Bonding and grounding to be added as required.
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
uc wut veu Uy [ne !ns eCior o Hires.
No. of 'Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. rnd.
o. o mergency Lighting
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
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals :
Number Tons
..........................................................
KW
No. of Self -Contained
Detection/Alertine Devices
No. of Dishwashers
Space/Area Heating KW
Local ❑ Municipal ❑Other
Connection
No. of Dryers
No. of Water
Heating Appliances KW
No.KW No. of No. of
Signs Ballasts
Security Systems:*
No. of Devices or E uivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail iy desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 0.00 (donated) (When required by municipal policy.)
Work to Start: 2/15/2023 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 thepains and penalties ofperjury, that the information on this application is true and complete.
FIRM NAME: Mark L. Avery
IC. NO.:
Licensee: Mark L. Avery Signature LIC. NO.: 13272
(Ifopplicable, enter "exempt" in the license number line.) L Bus. Tel. No.- 508-696-8890
Address: 77 Agnes Road, S. Dennis MA 02660 Alt. Tel. No.: rid-ssa oszs
*Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. S"02294
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: $