HomeMy WebLinkAboutBLDE-18-000515 Commonwealth of Official Use Only
ft- _` r'�i Massachusetts Permit No. BLDE-18-000515
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:7/27/2017
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) 1282 ROUTE 28
Owner or Tenant IMAD JAY TR Telephone No.
Owner's Address CEDARS OF LEBANON TRUST, 326 WEST MAIN ST, HYANNIS, MA 02601
Is this permit in conjunction with a building permit? Yes 0 No El (Check Appropriate Box)
Purpose of Building Gas Station 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: Disconnect, Remove, replace and reconnect fuel dispensers with like
dispensers. No breakdown or resealing of fittings is required. Interior scope is limited to changing a communication computer
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/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ 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: 07/31/2017 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 ❑ BOND 0 OTHER ❑ (Specify:) Bay State Regional(on file)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Randy A Babin
Licensee: Randy A Babin Signature LIC.NO.: 13508
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 100 ROYALSTON RD, PHILLIPSTON MA 013319403 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:$80.00
Town of Yarmouth Receipt No.: 28220
1146 Route 28
South Yarmouth, MA 02664 Receipt Date: 07/27/2017
508.398.2231
RECEIPT
RECORD&PAYER INFORMATION
Record ID: BLDE-18-000515
Record Type: Commercial Electrical
Property Address: 1282 ROUTE 28,SOUTH YARMOUTH,MA 02664
Description of Work: Disconnect,Remove,replace and reconnect fuel dispensers with like dispensers.No
breakdown or resealing of fittings is required.Interior scope is limited to changing a
communication computer board.
Will call for final inspection.
Payer: Bay State Regional Contractors
Applicant: Randy Babin
Randy Babin
100 Royalston Rd.
Phillipston,MA 01331
PAYMENT DETAIL
Date Payment Method Reference Cashier Comments Amount
07/27/2017 Credit Card PUBLICUSER310 $80.00
966
FEE DETAIL
Fee Description Invoice# Quantity Fee Amount Current Paid
Inspection Fee 30715 1.00 $80.00 $80.00
$80.00 $80.00
AA_Receipt_Template.rpt Print Date:10/24/2017 Page 1