The URL can be used to link to this page

Home My WebLink AboutBlde-19-000300 ,. Commonwealth of '� Official Use Only Permit No. BLDE-19-000300 _ Massachusetts 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:7/16/2018 City or Town of: YARMOUTH To the Inspector of Wires: / /� � By this application the undersigned gives notice of his or her intention to perform tca�ribed bel�,v. ^ ' , l.J N.V � Location(Street&Number) 86 WILLOW ST UNIT 1 ( I Owner or Tenant 11719 4 14 61 0t LLJIJry avnrv-t=tRRS Telephone No. Owner's Address •.. --•-- .. , c _ .=..._ a a ._._ -.__!.." --..,a!b! .42•:.. .,...,..:IA.. 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 rig! 1 o.' •rs ,,) , New Service Amps Volts Overhead 0 Undgrd ❑ N . , tep 'F. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install CCTV equipment.(BANK OF AMERIC 4‘Dpit 'Completion of the following table may v -, s. ctor of Wires. No.of 1 No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers ' No.of Luminaire Outlets No.of Hot Tubs Generators 'A 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 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* 5 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: WALTER REZNIKIEWICZ Licensee: Walter Reznikiewicz Signature LIC.NO.: 401 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:26 RAYMOND AVE, HOLYOKE MA 010401820 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:$115.00 nn// // Print Form Commonwealth o/f aooacIu ettd Official Use Only I = _ /, Permit No. g ( l —O -5C)® ew-, 2epartment oPire Serviced l_�— Occupancy and Fee Checked e BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07 ` ` j (leave blank) ;� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ),527 CMR 12.00 V (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: .... ' " y y-,_s- �e7to' -i 7 4, City or Town of: �Ct'rn2f-g)9i /a�L f' To the Inspector of Wires: 6 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,f ‘1,J//,b ) S7—. Owner or Tenant zf. J/ }f 1q?,...2p r7 47-41--- Telephone No. L Owner's Address . Is this permit in conjunction with a building permit? Yes 11 No n (Check Appropriate Box) C od Purpose of Building Utility Authorization No. "9 n Existing Service Amps / Volts Overhead Undgrd I l No.of Meters New Service Amps / Volts Overhead Undgrd No.of Meters Number of Feeders and Ampacity �, Location and afore of Proposed Electrical Work: ��/�Lc 7/v �!�t°�'fv Jz^Z�� /.iJG� Completion of the following table may be waived by the Inspector of Wires. No rano No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans T . f TVA Tr. 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 Self-Contained No.of Waste Disposers HeaTt Totals: Number Tons KW Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection i No.of Dryers Heating Appliances KW SecuriNo f SD vices or Equivalent.`J No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications qu ing: No.H Y g No.of Devices or Equivalent OTHER: �r Attach additional detail if desired,or as required by the Inspector of Wires. b `7 Estimated Value of Electrical Work: /S- (When required by municipal policy.) Work to Start: czle Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C /ERAGE: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME:Johnson Controls Security Solutions LLC _ LIC.NO.:401 C Licensee: Walter Reznikiewicz Signature v LIC.NO.•401 C (If applicable,enter "exempt"in the license number line) s.Tel.No.:781 680 0412 Address: 1400 Providence Highway Norwood Ma. 02062 Alt.Tel.No.:413 750 0200 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. 002272 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)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ 11.�- Signature Telephone No.