HomeMy WebLinkAboutBLDE-19-003157 V1k? Commonwealth of
Official Use Only
• Massachusetts Permit No. BLDE-19-003157
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
IRev.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
(PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date:11/21/2018
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) 484 STATION AVE
Owner or Tenant LINEAR RETAIL YARMOUTH#1 LLC Telephone No.
Owner's Address 5 BURLINGTON WOODS DR, BURLINGTON, MA 01803
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: Wiring for new teller.
Completion of the following table maybe 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- 1:1No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 6 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 ❑ Municipal ❑ 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: 4
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 ofperjury,that the information on this application is true and complete.
FIRM NAME: Shawn R Leahy
Licensee: Shawn R Leahy Signature LIC.NO.: 16609
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:457 LAUREL ST, HALIFAX MA 023381616 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: $100.00
8t-1 +/,e e-
Il yyj L s Print Form'"
JCommonwea�ih o/MamachasetG Official Use Only
� i MS
Permit No.
£(7 - 3 ( 5-1
'•.tr:�)Q apartment e`-Yire Services
iNOccupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (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 INFORMATIOIV) Date:
City or Town of: cat/F cyad/-1tV t/i To the Inspector of Wires:
By this application the undersign d gives noti a pf hjs or her intention perform the electrical work described below.
Location(Street&N�lumber) x( 74 Si-A.. /!j rt. {-f i /
Owner en t Cli'Z. -C°IS &w LA) S�ap{- S �p Telephone No.
Owner's Ad s
Is this permit in conjunction with a building permit? / Yes ft, No Q (Check Appropriate Box)
Purpose of Building llt it /, 'K r it 14 ei D e-/ Utility Authorization No.
Existing Service /(/it Amps / Volts Overhead 0 Undgrd 0 No.of Meters
New Service /tai-- Amps / Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Gid cad e. ,gr &r may',t it. 4 t
4 / Ru✓ -te,l(et H rl(wa//� , i ,..,e_ t.rrs
Completion"the followln&,able may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeO.Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above o In- No.of Lmergency Lighting
grnd. grnd. 0 Battery Units
No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of
Devices
No.of Ranges No.of Air Cond. TotaTons
No.of Alerting Devices
No.of Waste Disposers 'Heat Pump Number Tons KW No.of Self-Contained
Totals: ""'' Detect ion/Alerdng_Devices
No.of Dishwashers Space/Area Heating KW Local Municipal
Connection 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Dvices or Equivalent V
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Kirin :
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of 1 cal Work: 00 0.
3 (When required by municipal policy.)
Work to Start: 1/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURAN RAGE: 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 sante to the permit issuing office.
CHECK ONE: INSURANCE a BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application it true and complete.
FIRM NAME: Sullivan& McLaughlin Company LIC.NO.:16609A
Licensee: Shawn Leahy Signature ys r yt LIC.Nil.:16609A
(If applicable,enter"exempt"in the license number line) Bus.Tel.No..6174740500
Address: 74 Lawley St Boston Ma 02122
Alt.Tel.No.:6179384004
'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SS002265
OWNER'S INSURANCE WAIVER: 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
Signature Telephone No. I PERMIT FEE:$
CARPET PMN
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