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Home My WebLink AboutE-18-3655 0°. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-16-003655 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/07] 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:12/21/2017 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) 1146 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 ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 600 Amps 120/20E Volts Overhead ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Move a light switch,remove IT testing station form back wall(508-294-2416) 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 Transforme e/e KVA No.of Luminaire Outlets No.of Hot Tubs Generat KVA No.of Luminaires - Swimming Pool Above 0 In- ❑ No.of e y h'titi 8 grnd. grnd. Battery Um No.of Receptacle Outlets No.of Oil Burners FIRE ALARM . r n No.of Switches No.of Gas Burners No.of Detection and Initiative Devices d0 OV No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons .4 No.of Waste Disposers Heat Pump Number Tons KW No,of Self-Contained Totals: DetectionlAlertine Devices No.of Dishwashers Space/Area Ileating KW Local 0 Municipal 0 Othe . Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent /4 No.of Water KW No.of No.of Data Wiring: Heaters Stens 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 ❑ OTHER ❑ (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 J Carlson Signature LIC.NO.: 38869 (Ifapplicable,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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$0.00 • • •.�` ammerwca/t of///assac�.ue.6 Of,i Use Only • JJcPerf n:.r�of j' Jortrcoca ,..:Permit NO. 'alit:/7 6 e.3g$ Occupancy and Fee Checked BOARD OF ARE PREVENTION REGULATIONS Rev. 1/D7] (Irzve blank) ------- • APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK MI work to 6:performed in aecot•danct with the Massachusetts Electrical Coda(MEC),527 CMR I ZUO (PLEASE PRWTpNINKOR TYPE ALL INFORMATION Date: /1 — ) /— /7 City or Town of: YARMOUTH To the Inspector of FYtres: By this application the undersigned Oyes notice of his or her intention to perform the electrical work described below. Location (Street&Number) //t/& a/ 9_.r Owner'or Tenant /04.4.1-/�f Telephone No.i7yJaF fz2l/ �a77/a-r/z.elZ RI z� Owner's Address _//‘,/,./...4-.." 4/.02/7 Is this permit inunction with a brill ding a G +� con] nc permit? Yes ❑ No (Check Appropriate Box) ,e C'4 < Purpose of Building r-+ w /UG✓�//i5tl� Utility Authorization No. WICg o Existing Service (M' Amps / d/ • t p Joltr Overhead E Undgrd g No.of Meters Q New Service _ Amps / Volts Overhead Undrd ALA ❑ gr ❑ NO.of Meters i $,� ,. Num6=r of Feeders and Ampadty L • m m' Location and Nature of Proposed Electrical Work 44Ive -/fit , // jr"-- O/7rrluyr T ' )t f 7. �- • •••. .. ._ Conroleion ofthe forlowfriz table;Troy be ted by the Imrperlor of Wirer. No. of Recessed Laainai-es Na of CeB.-Stsp.(Paddle)Fans • INo,of Total Transformers KVA No. of LILMiltalite.Oatietr No.of Hot Tubs 'Generators • KVA ' No.of Luminaires Swimming Pool Above la- No,or Einem my la:ghtme erne- crud. o INo. r9meitr Naof Receptacle Outlets . No.of OE Burners 'ETRE ALARMS 'No.of Zones No. of Switches No. of Gas BartersNo of Detection and - Initiating Devices No. of Ranges Total No.Na of Air Cond Tons No.of Alert • No.of Waste Disposers Heat I Number Tons 'KW 'No.of Setf-Contained Totals; I Detecnonal erring Devices No. of Dishwashers S ace/M-ea Heating KW MuaiciFal F Local❑Connection 0 Other No.of Dryers Heating Appliances Kw Security Systems:° No.of No. of Water s KW No. of No. of Data w, Devices or Equi Heavalentvaient Signs Ballasts No.of Devices or Equivalent No, Hydromassage Bathtubs. No. of Motors Total HP Telecommnaications bluing Na of Devices or Equivalent _ • • Attach additional derail tf desired oro rehired by the Inspector of Wires. Estimated Value of Electrical World /p- (When required by municipal policy.) Work to Start: if- V-/7 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 inclnriing"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 Dim g(Specify.) I certify, under the pains and penalties of perfary,that the information on th' eppkcafion is true and complete. FIRM NAM,....7E: E: ,ff 7/;€' �01✓iv p/' \/�//l'tt�� LIC F NO.: Licensee: ra i 1"14/47/1" Signature C,y/ LIC.NO.: C 3074.1 (Ifapplicable, enter"a t"in the C e'umber line.) Address: r -g 7 /wiz( C X 6?v j) 0/4 • Bus.TeL No,er,r t J "Per NLG.L.c. 147,s.57-61,securitywork requiresAlt.TeL No. t a Department of PubtSe Safety"S"License: Lie.No. — OWNER'S INSURANCE WAIVER I am aware that the Licensee does nor have the liability insurance coverage normally requ r rA y claw. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent tSignature Telephone No. I PERMIT FEE: $