HomeMy WebLinkAboutBLDE-22-003781 #5 a.-r
ttt Commonwealth of Official Use Only
, Massachusetts Permit No. BLDE-22-003781
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:1/7/2022
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) 107 SOUTH SHORE DR
Owner or Tenant KJ INGOLD LLC Telephone No.
Owner's Address C/O SURFCOMBER MOTEL, 112 SOUTH SHORE DR, SOUTH YARMOUTH, MA 02664
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: Fan, light, &receptacle. (UNIT 5)
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 1 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 No.of Gas Burners No.of Detection and
lnitiatine 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 0 Municipal ❑ Other: Exhaust fa
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 Siens 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: Lance A Macenerney
Licensee: Lance A Macenerney Signature LIC.NO.: 11149
(If applicable.enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 126A MID TECH DR,W YARMOUTH MA 026732560 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: $80.00
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AEC 212021 k / kola, Official Use Only
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`�j;y cc77 Permit No. C 2(i .37[1
r—-r..+ NARTM a ni of.}ira-cervices
c y 1(? Occupancy and Fee Checked
PREVENTION REGULATIONS [Rev.1/07j (leave blank)
c APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
U All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
t
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (a(at l (
v City or Town of: ya(fT1,ii•.:{-h To the Inspector of Wires:
co By this application the undersigned gives notice of his or her intentionnt' to perform the el cal work described below.
1.1
Location(Street&Number) 10 5c w�h t s c Dr �(\I
Owner or Tenant Sulk Co rnhex- (�,0f�( Telephone No.
Ci. Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box)
W Purpose of Building Utility Authorization No.
, Existing Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters
Ct New Service Amps / Volta Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 51'4(( +C_,cALt r_Sk- i ax-,, Va r\t t 7 (t)h t
olnanui_e 4-0 Are.Fa,.\-k- C.F1 (ece(Yto,c(e5
Completion of the followingtable may be waived by the Inspector of Wires.
otal
ti� No.of Recessed Luminaires No.of Cell TransformersNo. KVA
VA
n 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 1Vo.of Detection and
Initiating Devices
11' No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertint�Devices
No.of Dishwashers Space/Area Heating KW I,o.al 0 Municipal ❑Otisw
Cyostnnection
No.of Dryers Heating Appliances KW See No. fDevices*or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters Signs Ballasts No.o evices or ecomt tuiivnallent
nunications
No.Hydromassage Bathtubs No.of Motors Total HP TeINo.of Devices or Equivalent
OTHER:
Attach additional detail(fdes(red or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: 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 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: F.,((ec E[e c - c e_u,neaV,y LIC.NO.: t((1 i q 7
Licensee: La flat (e yle(nel. Signature ---,_
)-- LIC.NO.:
(If applicable,enter'exempt in the license number line.) Bus.Tel.No.• a S-l)S-O C3 Address: I a L Fi 1,M;d --Vzc_lA. 1)f UV'1 l r'r1'1ed*l\
*Per M.G.L.C.147,s.57-61,securityworke81f]m� lic Safety Alt Tel.License: Lic No.
OWNER'S INSURANCE WAIVER: I am requiresware thatpthe Licenent see 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)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$ Ss LC-
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