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HomeMy WebLinkAboutE-19-725 Official Use Only co Commonwealth of �� Massachusetts Permit No. BLDE-19-000725 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:8/6/2018 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) 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 0 No 0 (Check opriate Box) Purpose of Building Utility Authorization N . Existing Service Amps Volts Overhead 0 Undgrd N' ' 411' : n New Service Amps Volts Overhead 0 Undgrd4r lrs Number of Feeders and Ampacity Q `t i- 4° ,Q Location and Nature of Proposed Electrical Work: Install receptacles in server room. Completion of the following table may 6 y;I ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of otal Transformers 'VA No.of Luminaire Outlets No.of Hot Tubs Generators VA No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 2 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 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: ROBERT J CARLSON Licensee: Robert J Carlson Signature LIC.NO.: 38869 (If 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 i Commonwealth of///a ac f Off/ciiiall Use Onl _ _ l= Apartment or..y�ire&rvius Permit No. �. '�-` f Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR°PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C�7 CMR 122 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /f 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) //y , . Owner or Tenant �G..401.1 or y/7.01,17,0'e--- -, Telephone No —3 -- M 7/ Owner's Address Is this permit in conjunction with a building permit? Yes 0 No a (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 6CAO Amps /0/2c olts Overhead 0 Undgrtja_ 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: arT -S��t' '4 XDD,P-7 TOP /--OOotof 4t A) 0' ,cD �iri, e lJTA/---- --d -we. 3D f}/i arG e ' re4-s ©U 1104 1pI/ i/,J AireLJ Completion of thefollowin&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 No.of Gas Burners No.of Detection and Initiating_Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 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 i• Connection No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW Wiring: 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 desire4 or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 0 �6 _, 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 ❑ OTHER ❑ (Specify:) I certify, under the pains and ye• s of perjury,that the information on this application is true and complete. FIRM NAME: ,doi '/ .. fyj�,il/4f��`��l? / LIC.NO.: Licensee: e v3 C.,./4/5-r�,r/ Signature 74- eLIC.NO.•e 3 7' (If applicable, ent 'exe�,t"in the icense mb line.) . Address: T v}t 1c / ���� 4 Bus.Tel.No.: J *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt LiTc. No. - 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. 1 Owner/Agent al Signature Telephone No. I PERMIT FEE: $ 1