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Home My WebLink AboutE-20-042 Commonwealth of Official Use Only E or Permit No. BLDE-20-000042 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:7/2/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electncal work described below. Location(Street&Number) 669 ROUTE 28 Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address PARK 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: YARMOUTH COUNTRY FESTIVAL. 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 Initiatinc 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/Alertinc 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 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.: 16945 (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:$150.00 * 77`t l tee— S )/I 9 acis, 7/t /ti. ( -E- l.ommonwerc of 927r ,4.4-H3 • Official Use Only le i/ _ ��_ apartment o f.yu+r Serviced No( � � Zj BOARD OF FIRE PREVENTION REGULATIONS O and Fee Checked • • V. 1/07]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: c 72'/>' 2 - ' /9 City or Town of: YARMOUTH To the Inspector of Wires: By this application the lrndersigned givesix°lice of his or her intentio to perform the,electrical work d scribed below. y Location(Street&Number) G �. ��`7er"" ( Q •(22- Owner.or Tenant 1flpl,4-td d 0�/ L' Telephone No, ZELIze7j �� Owner's Address i✓ f'p ' y�/I�(v � Is this permit in conjunction with a building permit? Yes ❑ No nn Purpose of Building � �l (Check Appropriate Box) Utility Authorization No. Existing Service /QO Amps /14' t 4/‘)Volts Overhead Undgrd ❑ No.of Meters / New Service Amps / Volts Overhead E Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeR.-Busy.(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 Lightmg - mad. e-nd. Battery Units No.of Receptacle Outlets No.of OR Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pomp I Number l Tons 1 j KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Macipal Conninection ❑ Other No,of Dryers Heating Appliances KW Security Systems:* No.of ater , No.o o.of No.of Devices or E uivalent Heaters Data Wiring: Signs Ballasts No.of Dvices or E uivalent i No.Hydro mass age Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No of Devices orEquivalent G>�t/7jl �jl k Ou.4o Attach additional detail ifderirecj or as required by the Inspector of Wires. Estimated Value of Electrical Wor (Whenrequired by municipal policy.) Work to Start: 7 —/ F -15 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 issuin office. CHECK ONE: INSURANCE 0 BOND 0 OTHER g I certify, under the pains and penalties o ❑ (Specrfy:) fperfury,that the information on this application is true and complete FIRM NAME: ac z /I. LIC.NO. /6 �j'�/r Licensee: �' / . (If applicable. ter "etc-apt Signature "in the licensber line. LIC.NO.: Address: 7, L, + Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires D Alt.Tel.No.: J OWNER'S INSURANCE WAIVER: Department of Public Safety"S"License: Lic.No. eWiby I am aware that the Licensee does not have the liability insurance coverage required law. By my signature below,I hereby waive this requirement I am the(check one Owner/Agent ❑owner o e n is ally Signature ❑owner's a enL Telephone No. PERMIT FEE: $