The URL can be used to link to this page

Home My WebLink AboutBLDE-19-001669 Commonwealth of Official Use Only atMassachusetts Permit No. BLDE-19-001669 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/07j 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:9/19/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his of her intention to pertorm the electrical work described below. Location(Street&Number) 62 HIGHBANK RD Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address BASS RIVER GOLF COURSE, 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 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: install receptacle for booster pump. 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 title n e 0 I - I 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 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 Siena 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 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 J CARLSON Licensee: Robert.)Carlson Signature LIC.NO.: 38869 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:39 NAUSET RD,W YARMOUTH MA 026733752 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 FEE:$0.00 cif; q/w(ie - n/7 ryyyy�r �. l.ommonmea of/r/allac ffl Official Use Only [� mi 1Jepar(menf al.yire...serviced Permit No. =;1;1= Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS cv, l/07j ' (leave blank) 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: //' /9 /F City or Town of: YARMOUTH To the Inspector of Wires: . By this application the pndersigned gives noticeof hi or her intention to perform the electrical work described below. • . Location (Street&Number) t 7 Mfa4�� d.,x� Owner'orTenant �.yiv dF y/'y,417tnigi 6£'4,C Telephone No. P Erzej Owner's Address Is this permit in conjunction with a building permit? Yes 0 No ® (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 Und grd 0 No,of Meters Number of Feeders and Ampacity — • Location an/d Nature of Proposed Electrical Work: ' /-�t 63 et N AdOy+7r 01/47 ec,n /3 n creA ,vim eV ,, e a S Completion of thefollowingsable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cet7 Susp.(Paddle)Fans o.of Total Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Fool Abovgrad. 0 Bae ❑ In- No.oftteryUnitEmergencys Lighting grnd. 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 Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number ITons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local Municipal ❑Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* — No.of WaterNo.of Devices or Equivalent Heaters No.°f 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 //—/c-IF- 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 BOND 0 OTHER 0 (Specify:) I ter*, under the pains and penalties of perjury,that the information on this application is tr e and complete. FIRM NAME: A' CNS i_ / LIC.NO.: Licensee:*QJ/^A / 0/4ce/s,,t) Signature ///t% LIC NO.:e_12.5_9,1 (If applicable.enter"exempt"in the license numb r line.) r/ Bus.Tel.No: Address. 7 �7c.Cj PCS j `Per M.G.L.c. 147,s.57-61,securitywork requires /,ty/ Alt.Tel.No.: Departs nt of Public Safety"S"License: Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragenormally required by law. By my signature below,I hereby waive this requirement I am the(check one) owner ❑owner's agent g- El Signature Telephone No. I PERMIT FEE: $