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Home My WebLink AboutBLDE-22-003786 #17 or r Commonwealth of Official Use Only t<. Massachusetts Permit No. BLDE-22-003786 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 ❑ 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 17) 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 Initiating 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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: 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 ' ' C.ommonweadth o/ aooachwatto Official !Jse Only tt--�� c�7'j {{�� Permit No. ( ' "� 376(.:, `oz apar n1 o/...}ire Serviced ,, l � Occupancy and Fee Checked . 1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK v_ All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 t. -I- (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: d a(a( (a( City or Town of: 'e((An o t: To the Inspector of Wires: 0 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 1 Location(Street&Number) 10 a1 5c,��\ S!-\occ �r {� �- I rj ��€ Owner or Tenant j`.,-4 G,)in ht.%- 4)t- 1 Telephone No. CI.f Owner's Address Qty Is this permit in conjunction with a building permit? Yes C No (Check Appropriate Box) VI Purpose of Building Utility Authorization No. 1 Existing Service Amps / Volts Overhead Undgrd E No. of Meters E New Service Amps / Volts Overhead❑ Undgrd g E No.of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed EIectrical Work: - s40 ck,n / ("('1titit ty fo Completion of the following table may be waived by the Inspector of Wires. tb No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 'A -t 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 1 No.of Switches No.of Gas Burners No.of Detection and Initiating Devices 1 t.1 No.of Ranges No.of Air Cond. Tans No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal p Local❑ Connection ❑ Other No.of Dryers Heating Appliances KW `Semy Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW Signs Ballasts Data Wiring: Devices or Equivalent No.Hydr+�massage Bathtubs Na.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: 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 El BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete., r/ FIRM NAME: 1-u.( (t✓c. E l e c_-E-u'‘L �v mean,/ LIC.NO.: ! t (' i `C Licensee:141 a6tv Prf, l i e a11_ s Signature ! -- —LIC.NO.: (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.; e) -'71 -6)$ Address: _(au f V"Y\ d � �- - �r \ ' t{MeLAh, 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 0 owner's agent. Owner/Agent Signature _ Telephone No. I PERMIT FEE:$ I