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Home My WebLink AboutE-18-800 or Commonwealth of Official Use Only Massachusetts Permit No. BLDE-18-000800 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.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:8/10/2017 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. Location(Street&Number) 340 ROUTE 6A Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address FIRE DEPT, 1146 ROUTE 28, SOUTH YARMOUTH,MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check A i , .nate Box) Purpose of Building Utility Authorization No. No. �ii'\lp O Existing Service Amps Volts Overhead 0 Undgrd O . t New Service Amps Volts Overhead 0 Undgrd Number of Feeders and Ampacity e Location and Nature of Proposed Electrical Work: Install receptacle for new dryer (/ Completion of the following table may 6,:II 1ó. �'or of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of /,��7 Total Transformers `rKVA No.of Luminaire Outlets No.of Hot Tubs Generators D VA No.of Luminaires Swimming Pool Above ❑ In- 1:1No.of Emergency Lighting ib /? grnd. grnd. Battery Units `�/'/( No.of Receptacle Outlets 1 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 o No.of Waste Disposers Ileac Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Ileating 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: 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 tfdesired 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: ROBERT J CARLSON Licensee: Robert J Carlson Signature LIC.NO.: 38869 (/fapplicable,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 tqR e c? i 4,_ w4 (? 7 lea , _�\.: l.ommunrrr of/r/aseechr<xltt rrOfficial Use Only'nn w V31 & ^v� c� Permit No. Et apartment o{5in.fie ' Occupancy and Fee Checked BOARD of ARE PREVENTION REGULATIONS Rev. 1/07] ' (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance wit the Massachusees Electrical Code 527 CMR 12.D0 (PLEASE PRINT IN INK OR TYPE ALLINFORM4TIOA) Date: p /7 City or Town of: YARMOUTH To the Inspector of Wires: . By this application the pndersignee�d gives notice of his or her intention to perform the elect wor described below. . Location(Street&YNumber) 3yD ',4 C# >/�f0fyvy/ZGn7T, r�ioz✓ q Own erbrTenant /OWE G— Y/'�n,nore ,,,/ ,',,,-;- io 1712. Telephone No.eP� 7„., Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No E (Check Appropriate Box) Purpose of Building corner 0.41-0241 �G,lo 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 Wort: Rifj. /ViYrf : a f/ ' 6,1 CiinciiCOY ad,YeA �jt Mire /14e„f O >..f -i_. .z . . .. . _. . Z' Completion of the follow:he table leamfay be wcdved by the Inspector of Wrer, m No.of Recessed Luminaires No.of Cert Susp.(paddle)Fans y Transformers KVA No.of LuminaGraeratnrs isVA ' ire Outlets No.of Hot Tubs - No.of Luminaires ISwi:nmiag root Abod_ve 0 In-ernd. Fir.of kUmergency lighting - orattety nits 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 . 3 No.of Ranges INn.of Air Cond. I ons Tons No.of Alerting Devices • No.of Waste Disposers (Heat Pump I Number I Tons I KWNo,of Self Contained Totak: Detection/Alerting Devices No.of Dishwashers SpacelArea Heating ICW' Local M clpa1 0 Connectiaa 0 other -3, No.of Dryers / Heating Appliances KW Security Systems:*o. No.of Water No.of No.of Data Wi evrces or Equivalent rinHeaters Sins Ballast No.of Devicesgor Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring - No.of Devices or Equivalent O1klER: - Attach additional detail tfdewed or as required by the Inspector of Wires. Estimated Value of Electrical World $'- `f— /7 (When required by municipal polity.) Work to Start r -9 — /7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. . CHECK ONE: NSURANCE OKI BOND 0 OTHER 0 (Specify:) I certify, under the pains and pear iss.2,f 4perfury,that the information on this application is true and complete. FIRM NAME: resibti )*Awn/ f�yl%./Zts• LIC NO.: Licensee:6Z eexre: 4/togs) Signator , i� LIC.NO.: g 8 (If applicable,a ter"exempt"in the f e numb Usti Bus.Tel No.•L_ Address. ,49 7 Amer U % C Al e/Ys 09,-1 Alt Tel No. j `Per M.G.L.C. 147,s.57-61,security work requires Department of Pu 'c Safety"S"License: Lie.No. „ee— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage norm Oally wrequired by at law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent 1 Signature Telephone No. . I PERMIT FEE:$