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Home My WebLink AboutE-18-576 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-18-000576 2 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked iRev.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:8/1/2017 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 ❑ Undgrd ❑ No.of Meters New Service Amps • Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install circuit for dishwasher and wire new booster for same. 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 0 In- 0 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 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 Number Tons RI KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers 1 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 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 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 ❑ (Specify:) certify,under the pains and penalties of perjury,that the information on this application Is true and complete. FIRM NAME: Stanley H Bullard Licensee: Stanley H Bullard Signature LIC.NO.: 39163 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:PO BOX 103, ORLEANS MA 026530103 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. PERMI/TFEE:$0.00 's .� •• �� l.emmoo+u „/777 zvee�+�.+-Ifs • • O�acial Use Only \c ., �s r'�{� [s ��-� -Ue)oarfinenf cf,yip Jcrvtcr3 • Peru Na. BOARD OF FIRE PREVENTION REGULATIONS 'Rev. 1/071upancy Ocend eeChccked Rev. 1/(17] Oeave blank) — APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK ,1:] F- All wort to be pc-formed in accordance wiT the Massachusetts Electrical Code(ME ,527 r 12,E1 ii u 1�1s I (PLEASEPRINT IN INK OR TYPE ALL INFORMATION) Date: , •1 N 117 h. City or Town of: y�MOUTH To the l cads . By this application the ers ed f u�' 1 , I M ! Ilmd . gives notice of his or her intention to perform the electrical work described below. • " Loca•oa (S Number) 1t..bt J T . ireet& Ie y. /_'.. y /A` ._co' i, 1. / n 51 !r OwnerbrTenant , t.. yr �_, t .� t J —' Telephone No, e try��j i Owner's Address . L.,,_,. Is this permit in conjttncti with a btoldinaermit? Yes F P ❑ (Check A.pproprisk Bar) Purpose of Building U ' Authorization No. Efistiag Service_ Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service _ .4mps I Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Luca oa and Nature of Proposed�.. Electrical Wort ^ I F _& .__ Pet eket r!.11�oklont Itb.tas i .. . . . b.,. Campietiar( ,the foiowlne table may be wem,ed by the Inspector of Wires. No.of Recessed Laes No.of Ceti sp.(Paddle)Fans • !No.of Total n:,, Transformers KVA No.of Luminaire Outlets No.of Hot Tabs 'Generators • ia'VA ' No• of Luminaires Above bi- Swfru bg Pool B a.oi Emergency ung =t-nd.. erad. � IND. Darts No. of Receptacle Outlets No.of O9 Burners IFM1 IF' ALARMS JNo.of Zones No. of Switches No.of Gas Emmert .Na.of D+«mon and No. of Ranges Total Iaitiati�Devices _ No_of Air Conde Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I'Tons IK W [No.of Self-Contaiard Totals: Dete ion/Alertino Devices No.of Dishwashers Space./Area Heating ICW Local❑Mnaicipal 0 Other No. of Dryers Connection rp Heating Appliances KW Security Systems:* No. of Water No.of Devices or Equivalent Heaters KW l'o. of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring O 1 lila: No.of Devices or Equivalent - • Estimated Value of El tri . WorldAttach additional detail if desired or as required by the Inspector of Wires. Workt Start / (When required by municipal policy.) INSURANCE C Inspections to be requested in accordance with MEC Rule 10,and upon completion. GE: 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 elf, ruder the pains and penalties of perjury,that'the information on this'appfcthon it true and complete. FIRM NAME: Q.. n C NO.: Licenserf� ice' ''_ >Y SI afore 0 A (lfapplicable, enter "es *a' . XQ.ir Tel. NO.:l �� Address. p��?nt `°the license tuber/ine�,),q • lj Bus. No(7A.1.) j 'Per M.G.L.c. 147, s:57-61/.0_7(+2..0.0w.,i. /P7 07:5-3 Alt.TeL No..` /,rte OWNER'S INSURANCEsecurity work ro res Department o Public Safety"S"License: Lie.No. ' �t WAIVER I am aware that the Licensee does nor have the liability S required by law. By my signature below,I herebywaive this �coverage normally (7 eragent requirement I am the(check one ❑ owner s Signature ❑owna'sa enc 01 Telephone No. PERMIT FEE: $