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Home My WebLink AboutBlde-20-000625 or Commonwealth of Official Use Only kE Massachusetts Permit No. BLDE-20-000625 . 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:8/2/2019 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) 96 OLD MAIN ST Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address FIRE STATION, 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: Wiring for replacement exhaust system. 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 0 In- 0 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:* 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 1 Total HP Telecommunications Wiring: No.of pevices or E,gyivalent , 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:$0.00 b, (5(i30 ' __ _ C.ommo►uusallh o////assachr�sslts • Official Use Only � l - 1JaParfinarrf o�.tirs Serviced No. V�/- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev- 1/07) (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7-2 /7 City or Town of: YARIVIOUTH To the Inspector of Wires: By this application the undersigned gives notice of is or her intention to perform the electrical work described below. • Location (Street&Number) 96 c 7 r5747/ S Owner or Tenant 74,A.j„ , �� / %�'n�I�r.'%�'"� Telephone No. G� Owner's Address ,/n't f'7-A97/o,,,/ Is this permit in conjunction with a building permit? Yes ❑ No . Gel‘ (Check Appropriate Box) Purpose of Building bin r S 1 / _ Utility Authorization No. Existing Service Amps /201 Molts Overhead —Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters Number of Feeders and Anipacity Location and Nature of Proposed Electrical Work: 7/ ,CIC 4i i — / 1 l'i$�� / /sv %G Ai...)Ai...) ;S' y s�7� I J 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 Transformer KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool Above In- No.of Irmergency Lighting grnd. � :rnd. Battery IInits No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS INo.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 I Tons I KW No.of Self-Contained J Totals:l Detection/Alertin_Devices No.of Dishwashers Space/Area HeatingKW Municipal kL� Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters ' Data Wiring: e 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: F ? ^ /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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the painsdand penalties of perjury,that the information on this applicatio 4s true and complete. FIRM NAME: / ,¢yit/t 7 LIC.:::jj , Licensee: 6 O a� jyl�C1;L 4 .�lam,/ S tgnature . L; (if applicable,enter npt in the licenseum nbs+_ij ) Address: }$ a ji c � 57 �� Bus.Tel.No.: J "Per M.G.L. c. 147,s.57-61,securi work requires Department of Public SafetyAlt Tel No.: "S"License: Lie.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)❑owner ❑owner's agent. Owner/Agent I Signature Telephone No. [PERMIT FEE: $ 1