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Home My WebLink AboutBLDE-20-001174 M Commonwealth of Official Use Only Massachusetts�,� :' Permit No. BLDE-20-001174 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:9/3/2019 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) 635 WEST YARMOUTH RD Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address RECREATIONAL&MUNICIPAL/WATER DEPT, 1146 ROUTE 28,SOUTH YARMOUTH, MA 02664-4463 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 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install receptacle for freezer. 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 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 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 ❑ 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 Siens 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� l.�omm nweatfh ofc/t'laddac th ,- • Official Use Only E:C s / .1JaPa ma sE o f.dirt Serviced : Permit No. / 1'�' f1_ fij=_. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. I/07] (leave blank) 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: City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his her intention to perform the electrical work described below. Location(Street&Number) bi 1 Sr Y�.�m� i(mil/ j , yi� 4W J� J Owner or Tenant £ �� - 69%4' Telephone No. J.9 ,f55.7 Owner's Address roi',v 01 >9,17lyle,0.-",r //y . j.er Is this permit in conjunction with a building permit? Yes ❑ No , Purpose of Building �� T .. . (Check Appropriate Box) 6a 6�9n a6/7f!/� Utility Authorization No. Existing Service Amps / Volts Overhead ❑, Undg rd❑ 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: 4Gt� / dU ✓ -� O� _ Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cea1.-Susp.(Paddle)Fans No.of Total Transformers ICVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- "No.of Emergency Lighting t rod. grnd. ❑ Battery Units No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS 1No.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Iaitiating Devices No.of Ranges Na of Air Cond. Tom Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW 'No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local D Municipal _ Connection ElOther No.of Dryers Heating Appliances , Security Systems:* No.of Water , No.of Heaters Sighs Ballasts No.of Devices or Equivalent No.of Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - OTHER: No.of Devices or Equivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Workk (WhenWork to Start:S</�%2- / required by municipal policy.) 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: INSURANCE El 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: (4%r /h,0,�4,1•1 e7 Z / G, ' !jt'/!h Licensee: g� �/j" Ay�a�,.� Signature � LIC.NO.: �Gu p (If applicable,enter"exempt"in the licens number ine) �� LIC.NO.:� 8�'6 . Address: 5257 . eel- 2-5-49N� �� U y50 o J'"? Bus.Tel.No.: ,,,1 "Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety _ Alt.Tel.No.: — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liabilityLin.No. � insurance coverage n�— 5 required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 ownero Owner/Agent0 owner's a ent ISignature - Telephone No. . PERMIT FEE: $