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Home My WebLink AboutBLDE-17-000391 (2) L or Commonwealth of OtFcialUse Only irE !►►` Massachusetts Permit No. BLDE-17-000391 • — BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.l/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:7/25/2016 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. Location(Street&Number) 400 HIGGINS CROWELL RD Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address 1146 ROUTE 28,SOUTH YARMOUTH,MA 02664-4463 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building School Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Annual Maintenance permit 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- o No.of Emergency Lighting rnd. grnd. 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 No.of Air Cond. Total No.of Alerting Devices Tons o.of Waste Disposers (teat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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 Data Wiring: Heaters Siem Ballasts No,of Devices or Equivalent No.Ilydromassage 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: RUSSELL E MEALEY Licensee: RUSSELL E MEALEY Signature LIC.NO.: 14020 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 SIGNE RD, DENNIS MA 02638 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$0.00 . Commonwealth of Massachusetts Official Use Only 2 i?. rc� ?i Permit No. ' ' fl O 3 9 Departmentt. of Fire Services • BOARD OF FIRE PREVENTION REGULATIONS Permit Fee Assigned(leave blank) 11/99] APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use The standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7/14II4, City or Town of: by , yNr mo4.4, To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution Macll..5e M;Ad!e Sc.Loo l Address Hon W:pcji v.5 Cr mot Ra. Location and Nature of Proposed Electrical Work: mar /Pwv re I P/b — 611/34 NOTE: C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion,or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advan ot yy�� i' ' al; ties may set nominal fees for annual permits and require individual permits for work above a stzte n�udE I V E q We will file this form on each such occasion(check one): YES ❑ NO 121 We will maintain one or more contemporaneous log(s) (check one): YES [] NO 0 JUL 25 2016 This option is available where so contemplated by the municipality. In these cases,you must re-lev this application annual,y, • and upon significant changes in employment. By BUILDING DEPT. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the logs)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage,and location where it will be maintained Responsible person __ Scltooldude elcc4v;co, Wovx Oracrs 1.4; 11 he S 4- 4-o e itc.$r ;ca1 tVISrt l:a-oY You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure,indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: I Full-time equivalent electrical employment: I How many helpers or apprentices do you employ to assist your licensed staff;under their direct supervision(see c. 141 §8)? In general,this number must not exceed The ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962,c.582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: () Full-time equivalent electrical employment: 0 Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How • many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: 1 Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141§8. (Please see reverse side for certifications and required signature.)