HomeMy WebLinkAboutE-18-6625 Or Commonwealth of Official Use Only
116Massachusetts Permit No. BLDE-18-006625
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:5/23/2018
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) 1314 ROUTE 28
Owner or Tenant PATEL MOHANVHAI TRS Telephone No.
Owner's Address JALARAM VANI REALTY TRUST, 1314 ROUTE 28,SOUTH YARMOUTH,MA 02664
Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate Box)
Purpose of Building motel Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Adding 2 lights on stone wall near building entrance doorway.
Need a trench inspection first.then a final.
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 2 No.of Hot Tubs Generators KVA
No.of Luminaires 2 Swimming Pool Above 0 In- a '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 Cas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Tootal No.of Alerting Devices
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 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.Hydromassage Bathtubs No.of Motors Total IIP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail rjdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: 05/22/2018 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: EDWARD L MERRY
Licensee: Edward L Merry Signature _ LIC.NO.: 17137
(If applicable,enter"exempt"in the license number line) Bus.Tel.No.:
Address: 15 CHECKERBERRY LN,W YARMOUTH MA 026733636 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 Tele hone No. PERMIT FEE:$130.00
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