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Home My WebLink AboutE-19-5508 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-19-005508 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:4/2/2019 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 electrical work described below. Location(Street&Number) 1146 ROUTE 28 Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address 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 renovations of offices in rear of lower level. 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 Initiatine 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/Alertine 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 ofperjury,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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$0.00 • u 3 aj rte, dEt u tu6 G b .) 5(1z (tot 43ecr i4o 12,4 KOs(vd) (...omnwruusatth 7 ///assackcdslt6 • Official Use Only -�i= • � st �7i Permit No. parimcs t o�Frs Services BOARD OF ARE PREVENTION REGULATIONS Occupancy and Fee Checked '',•. ��` [Rev. 1/071 (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: /—f — /? City or Town of: YARMOUTH To the Inspector of Wires: By this application the t,mdersigned gives notice of his or ntention to perform the electrical work described below. Location(Street&Number) //5'6 Owner or Tenant Q O > 74io - p J 7/ Telephone No. Owner's Address Is this permit in conjunction with a budding permit? Yes ❑ No Purpose of Building /v!z/� ,'f 9 / '5e ❑ tion(Ch N Appropriate Box) d/4fi;rs Utility Authorization No._ 6 Existing Service 4'd0 Amps /f.1%'/1_0‘21olts Overhead ❑. Undgrd t'T ® No.of Meters New Service Amps / Volts Overhead ❑ 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 Wirer. No. of Recessed Luminaires No.of CeiL-Snsp.(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.o1 Emergency Lighting - crud. crud. ❑ Battery Units No. of Receptacle Outlets fo No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches A 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 Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting_Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Omer No.of Dryers Heating Appliances , Security Systems:* No.of Water No. of No.of Devices or Equivalent Heaters KWNo.of Data Wiring: Signs Ballasts 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 Work: (When required by municipal policy.) Work to Start: V-2 -/Y 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 0 OTHER El (Specify:) I certify, under the pains and pen ties of erju ,that the infortnaivn this application is true and complete. FIRM NAME: /f/?,��7 on 1 47//V/ ,T � � LIC.NO.: Licensee: /S/6/ SignaturV. (Ifapplicable,e d emp n the license nu er line.) IC.NO.:� Address Bus.Tel.No.: J Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safe Att.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havethe liability insurance coverage normally S required by law. By my signature below,I hereby waive this requirement. I am the(check one o Signature. ❑ caner ❑owner's a enL 1-11 Telephone No. PERMIT FEE: $