The URL can be used to link to this page

Home My WebLink AboutBLDE-19-2163 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002163 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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 ININK OR TYPE ALL INFORMATION) Date:10/11/2018 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) 1175 ROUTE 28 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: Wiring for new gas train and emergency shut off switch. 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 ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 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 KW No.of No.of Data Wiring: Heaters 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 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: Neil H Sorensen Licensee: Neil H Sorensen Signature LIC.NO.: 21929 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:65 COURT ST. NEWTON MA 024581262 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:$80.00 Cnn • O, 10 r7 its eF_ RECEIVED .r-' OCT 11 2018 • .. yy� r 'al Usc my t,' ^"l aING DE PARTME • 'nwra of/r/aeeac�iueafte 9`-t�_ o-V t �t (7 Permit No. (� ga+.zz^ eparinu d o f }irr Serviced t -� Occupancy and Fee Checked • BOARD OF FIRE PREVENTION REGULATIONSt44 [Rev.1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Mt work to be performed in accordance with the Massachusetts Electrical Code NEC),537 CMR(2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /0/)I zoic City or Town of: Ye,r,M It//A 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) // 7 r /Zo✓/'r. iF Sn✓7`i( t .rntav'4 Atilt nS 4‘4 Owner or Tenant , AA / /�`r�(S v_ u/n-/e r- S><is'fv OA 7✓P./`S;71--y Telephone No. S0,4r- f31-/Rif fi Owner's Address /3/ 50,. t/' s,L. Br%ds e ,ate r . •h1.37 S' Is this permit in conjunction with a building permit? Yes 0 No E (Check Appropriate Box) , Purpose of Building ce AeB / Utility Authorization No. Existing Service_ Amps / Volts Overhead 0 Undgrd❑ No.of Meters _ New Service _ Amps / Volts Overhead 0 Undgrd❑ No.of Meters _ Number of Feeders and Ampacity n Location and Nature of Proposed Electrical Work: B,1 /e r- IAA"t. A e t✓ /r-A, +. Tra)4 mra tM6ryy ktry n deer- stat 7I-c-1-. ll Completion of the followingfable may be waived by the Inspector of Wires. vivNo.of Tota 1.5 No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA C' p No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Lmergency Lighting g mid. grad. .Battery Units `I No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 7, No.of Gas Burners / No.of Detection and c Initiating Devices Ill No.of Ranges No.of Air Cond. Total No.o f AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons _KW .. No.of Self-Contained F Totals: — Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ MCuniciponnectional 0 Omer No.of Dryers Heating Appliances KW Security SysteDevicms:* or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWSigns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications of Devic Devices Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrics Work: /lo? (When required by municipal policy.) Work to Start: / /Z / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CON RA E: 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: cent-5 e r }KGer:, /'g .In(7,1 LIC.NO.: Z.19Z-9 Licensee: /Ye.%l N. SareiSrr- Signature � �.� LIC.NO.: 2.iI.LI (If applicable,enter"exempt"in the license number line.) Bus.Tel.No; Li 7-33L-3700 Address: 45 /Aurk .9' A/ia/h& 411 OZ,9-fr- /26L Alt Tel.No.:ii?-tot- 1143 *Per M.G.L.c. 147,s.57.61,security work requires Department of Public Safety"S"License: Lia No. OWNER'S INSURANCE WAIVF,R: I am 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)0 owner 0 owner's agent Owner/Agent PERMIT FEE:$ Signature Telephone No.