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Home My WebLink AboutBlde-20-000626 Commonwealth of Official Use Only *� Massachusetts Permit No. BLDE-20-000626 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: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) 340 ROUTE 6A Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address FIRE 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: 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 ❑ 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 ❑ 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 Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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 P19(1 1 63 co-ea6e AA;31 tilopki40) 6C - /12 f � //�� yy� 2. ■ _. Commonwealth ofecMa..isac ffs _Official Use Only rig/ �CJeparfinent al girt&rvi 5 Permit No �t/,,VnJ �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked v. l/07] (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE ALL INFORMA77O Date: �,527 / 1 ZllO City or Town of: yARMOUTH To the Inspector of Wires: By this application the undersigned es notice of his or her intention to perform the electrical work described below. • Location (Street&Nnmber) 3 TQ 7 ir-6- 6L Owner.or Tenant 9"',h,et, 6,7f Y nv-ifa`,,,./7 Telephone No. s"5I3 Owner's Address .7 if 2�3/ Is this permit in conjunction with a building permit? Yes D No �It— � . (Check Appropriate Box) Purpose of Building /Ar t` Utility Authorization No. Existing Service Amps /7o/er;/ 'olts Overhead Undgrd ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature'of Proposed Electrical rk 4�N�/) ) ,tire,.) ,f>c&p.., coal �vs' f y �i✓� I 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 Swimmiag pool Above ❑ In No.of t.mergency Lighting ernd. grad. Battery snits No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and J Initiating Devices No.of Ranges No.of Air Cond. Total . Tons No,of Alerting Devices No.of Waste Disposers Heat Pump I Number(Tons `KW No.of Self-Contained Totals: f ! _Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local Q Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems;* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydroinassage 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 Work (When required by municipal policy.) Work to Start 7- 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 pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 73/ef' Of7i'7i2✓✓o¢i?/pfrl/C? Licensee: G� ll Signature LIC.NO.: (If applicable, exempt"in the license mb r line.) LIC.NO.: �� . Address: ,c 7 �/ air ..'s/�,�r��-/ Bus.TeL No.: ' i�- • J `Per M.G.L. c. 147,s.57-6I,security work requires Department of Public Safety"S"License: Alt.Lic.No.. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally ly required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner ❑owner's a ent. Owner/Agent 1 Signature Telephone No. PERMIT FEE: $