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Home My WebLink AboutBLDE-19-1960 a Commonwealth of Official Use Only tek Massachusetts Permit No. BLDE-19-001960 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/07) 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:10/2/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm 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: Replace two pole lights with LED. 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 2 Swimming Pool Above 0 In- o No.of Emergency Lighting grnd. grnd. Batten/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 Disposes 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 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:) !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 J Carlson • Signature LIC.NO.: 16945 9f 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 &J. 10(9//te Gta t __ teominonwea& Massachusettsofec7- triOfficial Use Only/ o :ni_ .(JrParlmrnl of Yirr Jrrvicd Permit No. �--(Pt C i lr7 BOARD OF FIRE PREVENTION REGULATIONS ev. I//00ncy and Fee kv. 7] (leave blanank)) APPLICATION FOR•PERMIT TO PERFORM ELECTRICAL WORK AU work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1100 (PLEASE PRINT ININK OR TYPE ALL INFORMATIOI9 Date: /D • 2 - AC City or Town of: YARMOUTH To the Inspector of Wires: • By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. • Location(Street&Number) 1/'fc. ' 4107- j r Owner or Tenant ),Arg siAf r f2rTy -G 74iiQq Y1410, 1ephone No. ,3y 3, Owner's Address 7p W "��`� Is this permit in conjunction with a building permit? Yes 0 No '® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ,<QD Amps 46 deg-Volts Overhead 0 Undgrd®-'No.of Meters New Service Amps / Volts Overhead 0 Undgrd g 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: 2 . 14i i../y- fD /...4,17/ arinoy7J e4/ 36'D 440r Completion of the following table may be waived by the Inspector of Wirer. No.of Recessed Luminaires No.of Cert-Snsp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 9 Leos S ming Pool Above 0 In. 0 No.ofttery EUnitsmergency trghtmg - vmd. ;•tnd. Ba 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. Ton No.of Alerting Devices No.of Waste Disposers Heat Pump I Number ITons IKW No.of Self-Contained - Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal - ❑Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:' - No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Sighs Ballasti No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP telecommunications Wiring: - No.of Devices or Equivalent OTHER: Attach additional detail ijdesired 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 issuing office. CHECK ONE: INSURANCE 0 BOND 0 OTHER ❑ (Specify.) I certify, under theptr zzr and penalties of perjury,that the information on this application is true and complete. FIRM NAME: /t'cW i!?? 7.%' y4 e /. W 'T es LIC.NO.:complete., FIRM Licensee:ar7Tclf4/fp/,/ Signature(�, gn (5P,,,,/ i _ NO.: 3�/r (If applicable.enter"exempt"in the license number line) Bus.Tel.NoT . : Address: j 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License: Alt L.io No. net - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n—normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent j Signature Telephone No. ( PERMIT FEE: $