HomeMy WebLinkAboutBLDE-19-006701 or ttu Commonwealth of Official Use Only
Permit No. BLDE-19-006701
�c 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:5/28/2019
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or tier intention to pertorm the electrical work described below. +per
Location(Street&Number) 2 FRANKLIN ST In
,0
Owner or Tenant BEATON TIMOTHY P Telephone No. rib
Owner's Address 90 ASPEN HILLS WAY SW,CALGARY,AB T3H 0G7 .\S\ s
Is this permit in conjunction with a building permit? Yes 0 No 0 (CheckA9propriate Box)
Purpose of Building Utility Authorization No l
Existing Service 100 Amps Volts Overhead ❑ Undgrd 0 .
New Service 100 Amps Volts Overhead 0 Undgrd El No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Upgrade service.
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
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
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/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Joseph Rego
Licensee: Joseph Rego Signature LIC.NO.: 14348
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:30 OLD MEADOW RD, BREWSTER MA 026312630 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: $50.00
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2. -: i; -'
' �� /c� t�cial Use Only
BOARDel -�'trr ss, Permit No._&a___4apaO_._.
OF FIRE PREVENTION REGULATIONSan
APPLICATIONto
FO andF Fee �_
(PLEASE `C`°I°°� PERMIT TO PERFOR
PRINTINArKOR TYPE diLL INFO with7701Electrical tM ELECTRICAL WORK
��'or Town of: OT1011� Date: J;a 1200
B3'this application the fined v 11 -
Location(Street&Nnmbe:s gives notice of his or h intention to To the jn�eccal ofkde
PO Owner or Tenant p F�9n�1. the e Wires:
NOwner's Address �` t �e.-) ��'O described below.
is this permit is con a 6 Telephone No. _y�/-
fnacdon
Purpose of$ building permit? y9
•
E S Yes ❑ No
Ne��Service-�QQ, Amps /�,�,� .'.------U�9 Authorization �p�p�ate Box)
" Si . Q. Amps !a V° Overhead�' Und. n No. ofM/ �o
amber of Feeders and Pap �'°� Overhead® Un No. Meters
14)
# Limon -1__and Nacre of proposed Electric Work, a❑ NO.of Meters
No.of Rased Luminaires
No.of Ltta re OutletsNo,of Celt, (Paddle)p• i ans : • _ o„ be w the I
•
• No.of Luminaires
+of got robs
�'anstormers •ic•vi r o
No.of Receptacle OutletsSwinunik Poo! •dve ❑ Generato� [CyA
No.of Oil Biers d. ❑ B ,. II cY s+r ,qng
No.of Gas ALARMS No. Zones
No.of Waste Na of Burners • ' `o.o .....„ of
D�Posers Air Good. o Imes Devices
To
N0.of Dishwashers Totals:
=� „ No.of Al
`o.o .,,�n sT�ces
No.of Dryers Space/Area Heating KW oNAtertln_ Devices
'4PPttancesOt�r
Heaters KW `o.o Kti' amity a 0
No.Hydraiaassa �� Si„: Ballastso a •
No.of,auks or :. ,
Bad to ant
No.Hyd No.of Motors Tom RP . No,of Devices or •uiv
OT
aOman es•oas �,r cleat
Devices or :.uivalent
Estimated Value of Electrical Ar
EsWo to Start: S: Atta Qddrlioncl detail ifdesi or as
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the licensee y ��GE: U o s b berequested inorE
by municipalitM ulic Q,and udby completion.pon Inspector njiPsres.
undersigned Proof of liabt• y the owner,no accordance a MEc Rule IQ,geed certifies that such insurance inching K� Permit for the pe Cotm ncefie of electrical
2HECK ONE: coverage is in force exhibited
operation" work ui
3 under INSURANCE ED o BOND ,and has 0bited Proof of coverage O1 substantial y issue cmless
FIRM N .���pe�t�s of �,��Q(Specify:)
�to the Permit issuing°��a[cnt. The
Licensee:_`�+� �%r f won on this apPon is
(IlQpp 4'ae aria!complete.
�Addt Address: [erj •�u,the license number Mee.)
Signature
Lie.NO.:�y
J Per M.G.L.c. 147, �6I y y
s.57 K-t�J LIC.NO.:
- OBus.TeL
'�c required R'NER S WSURANCE Writy work requires ' N.No.-
R' 1IN 8y my signature WA ER: I I�aware d the Lic dboet not �?�y �tr�No - 1
-'' Agent the Li
u waive I the lability prance --,._
the(check one t♦ owAefCOe normally
Telephone No. _ /owner's _^ t