HomeMy WebLinkAboutBLDE-19-003118 WY CENTER Commonwealth of Official Use only
Massachusetts Permit No. BLDE-19-003118
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:11/20/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives no ice o ns or er men ion o per orm e e ec ica Y4íaU
described below.
Location(Street&Number) 517 ROUTE 28 T &th-ei
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ 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 communicator&horn/strobe.
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
grad. 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 1
Initiatine Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices 1
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 Siens Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 2
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 K Boucher
Licensee: Robert K Boucher Signature LIC.NO.: 1317
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:218 SETUCKET RD,YARMOUTH PORT MA 026752258 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
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Commonwealth of Massachusetts Official Use Only►+ -- i l Permit No. CaQ^ (. ( e
Department of Fire Services
\ �( Occupancy and Fee Checked
,-- ---,. BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: 11/15/18
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) 525 Route 28, West Yarmouth,MA
Owner or Tenant West Yarmouth Center Telephone No.
Owner's Address
I\ Is this permit in conjunction with a building permit? Yes X No X (Check Appropriate Box)
`` Purpose of Building shopping plaza Utility Authorization No.
�......_ .. �. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
,'' .. .NawSet�vice Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
., ; - tumberY of Feeders and Ampacity
;'"0 ` Location and Nature of Proposed Electrical Work: Install sprinkler communicator in sprinkler room and new
horn/_stt obe on front of building per fire alarm permit.
Completion of the following table may be waived by the Inspector of Wires.
Total
. No.eif>! ecessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tr ofA
z'NJ:__ Transformers KVA
.No.of Luminaire Outlets No.of Hot Tubs Generators KVA
-_r.. "" —"No:ot"Luminaires Swimming Pool Above ❑ In- ID No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 4
No.of Detection and
No.of Switches No.of Gas Burners Initiating Devices 1
No.of Ranges No.of Air Cond. Tons Tons No.of AlertingDevices 1
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 No.of No.of
KW Data Wiring:
Heaters
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 2
No.of Devices or Equivalent
OTHER:
Attach additional detail if desirecl or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 1200 (When required by municipal policy.)
Work to Start: 11/13/18 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 X BOND ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties ofpetjury,that the information on this application is true and complete.
FIRM NAME: Seaside Alarms inc. LIC.NO.: 1317C
i
Licensee: Robert K. Boucher Signature" - /�ter ?LIC.NO.:
(If applicable,enter "exempt"in the license number line.)
Address: 1265 Route 28,South Yarmouth, MA 02664 Bus.Tel.No.: 508-394-0599
Alt.Tel.*Security System Contractor License required for this work;if applicable,enter the license number here:No.: S-0046
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 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: $ //.5��U ---