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Home My WebLink AboutBLDE-16-006361 (2) OfticialUseOnly Commonwealth of E` !►► Massachusetts Permit No. BLDE-16-006361 . _ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/071 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:5/24/2016 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) 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 Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd ❑ 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: Institutional Permit.(LOCATION IS MATTACHEESE MIDDLE SCHOOL) 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 a - ❑ 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 Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices o.of Waste Disposers heat Pump Number Tons 1 KW No.of Self-Contained Totals; Detection/Alerting 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 Signs 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 fdesired,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 (Ifapplicable,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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT ! !! E L ` MAY 24 2016 BUILDING DEPT. By __ F I _ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Permit Fee Assigned • BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/99] (leave blank) 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 TYfPE' ALL INFORMATION) Date: 5- f% -1 C, City or Town of: W•jatirtouth MA- To the Inspector of Wires: By this application the undersigned gives rrf lice of the on-premises performance of electrical wo b e ploy61 Institution Me1ettf—nhP,P.`>-t1 A 1 i cfrA if? 3r-i DO I �J Address no Hi rn Crotut ( 1�d. Location and Nature of ProMed`JElectrical Work: L'.1 /Part i P/o "6,i-7-V 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 advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES ❑ NO 16 We will maintain one or more contemporaneous log(s) (check one): YES V] NO ❑ This option is available where so contemplated by the municipality. In these cases,you must renew this application annually, • and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)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 3ckawlductr. e'lecxrtrr 2 t, c$C Ort.terS czx. actshtn tut ll R2 Ser1* rnontfil.i -fry ekrirtca 1 hn sp2c-1-or 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: 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: 0 Full-time equivalent electrical employment: C 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: I 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.)