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Home My WebLink AboutBLDE-19-001386 a. Commonwealth of Official Use Only UM Massachusetts Permit No. BLDE-19-001386 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked f Rev.l/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 MK OR TYPE ALL INFORMATION) Date:9/6/2018 City or Town of: YARMOUTH To the Inspector of Wires- By this application the undersigned gives notice of his or her intention t c Corm the electrical w described belo Location(Street&Number) 938 ROUTE 6A LF 2,,“/1s ll Owner or Tenant I13;fiRglellit Telephone No. Owner's Address 938 MAIN ST,YARMOUTH PORT, MA 02675-2172 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 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: Repairs to existing space. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires I No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators INA No.of Luminaires Swimming Pool Agrnd.bove 0 I grnn-d. CINo.of Emergency 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 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* „No.of Devices or Equivalent No.of Water ICV No.of No.of Data Wiring: Heaters ,Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs 1Telecommunications Wiring: ,No.of Motors Total HP 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: ROBERT F THIBEAULT Licensee: Robert F Thibeault Signature LIC.NO.: 22475 Qfapplicable,enter"exempt'in the license number line.) Bus.Tel.No.: Address:36 GOVENOR BRADFORD RD,BREWSTER MA 026312806 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) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$80.00 9f- vto(ee re...- Dei s i/ rice KK __ s lamtnonwea�of///amachuyetle Official Use Only ccyy c7 p ICA =.`1+- Aparimant of,yin Jmvicr<s Permit No. ' - BOARD OF FIRE PREVENTION REGULATIONS Occupancy 7) (leand Fee Checked) 1/07] (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical CodeC),$27 CtvIlt 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /4 I/Y City or Town of: YARMOUTH To the Inspector of Wires: . By this application the lmdersigned gives notice of his or her intention to perform the electrical work described below. . Location(Street&Number) 7.36; /4 r AA Owner or Tenant PJAeC O/L/jsa.A-0 Telephone No. ®) Owner's Address IIs this permit in conjunction with a building permit? yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Nil Existing Service libo Amps (20 /Z`f oyoles Overhead 0 Undgrd Q/No.of Meters .S— New Service Amps / Volts Overhead ❑ Undgrd 0 No.of Meters 1...N tuber of Feeders and Ampacity /— q O e • Lu sL ation and Nature of Proposed Electrical Work: p 1 SCboref rcr &WC7btc_Baer/ft 4 2tc._ m ? CV L 8/-4444.. /9i.,q Th. /1//3 C C . 4 ^ �p Ian • Completion of the folow,g table may be waived l the Inspector of Wires. LIE olNp.of Recessed Luminaires No.of CeB Susp.(Paddle)Fans No.of Total V L Transformers KVA �- rigr.of Luminaire Outlets No.of Hot Tubs Generators KVA I1� N • L. J.of Luminaires Swimming Poole ❑ � ❑ No.of Emergency Lighting K — Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.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 • No.of Waste Disposers Heat Pump I Number 'Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Mupal Local❑Connectinicion 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - No of Devices or Equivalent OTHER: Attach additional detail ifdesired 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)'ssuing office. CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:) Cat"e 9ct 712-7x`7 I certify,under the pains and pen aides of perjury,that the information on this application Zr true and complete. FIRM NAME: �d� � ��' LIC.NO.: Licensee: tyr{� Signatu /q e LW.NO.: y— (If applicable enter"exempt"in the license number line) C Bus.TeL No.s�g•L, 7�/734 Address: P6 Ga'. ?I7D1r.¢taj /L,D en:at AO4CC 01-63( j *Pet M.G.L.c. 147,s.57-61,securityworkAlt.Tel.No.: requires Department of Public Safety"5"License: Lic.No. �'-- - OWNER'S INSURANCE WAIVER: I sun 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 d owner's'gert Owner/Agentco 01 Signature Telephone No. I PERMIT FEE:S