HomeMy WebLinkAboutBLDE-20-000874 Commonwealth of Official Use Only
Permit No. BLDE-20-000874
(fLP1" Massachusetts
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:8/15/2019
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) 210 STATION AVE
Owner or Tenant DENNIS YARMTH REGIONAL SCHOOL Telephone No.
Owner's Address STATION AVENUE,SOUTH YARMOUTH, MA 02664
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: Replacement commercial dishwasher.
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 1 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 Signs 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: SCOTT D MORRIS
Licensee: Scott D Morris Signature LIC.NO.: 18338
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:PO BOX 1264, HARWICH MA 026456264 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
Commonwealth of Massachusetts Official Use Only 674
t Permit No.
1 _ Department of Fire Services
IttLff i Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
,. (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: 08/12/19
City or Town of: Yarmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intenti n to perform the electrical work described below.
Location(Street&Number) 210 Station Avenue (Dr..IS
Owner or Tenant Town of Yarmouth Telephone No
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Building Commercial Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
0 Location and Nature of Proposed Electrical Work I Wiring for replacement commercial dishwasher system.
W cr � Completion of the following table may be waived by the Inspector of Wires
o Noi f ecessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
c` kg. Transformers KVA
W tr)NoAf uminaire Outlets No.of Hot Tubs Generators KVA
0 ` Above In- No.of Emergency Lighting
0 No 0uminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units
W Q 'La :
ce
No lif eceptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
—. .._.
No.o itches 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❑ Muntctpal ❑ 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 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: 08/08/19 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 proo . :me to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER 0 (Speci .
I cert fy, under the pains and penalties of perjury, that the informatio on th.. application is tr and complete.
FIRM NAME: SDM Electric,Inc. LIC.NO.: 18338A
dro ., ,
Licensee: Scott D.Morris Sign, re, 446LIC.NO.:
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508 430 4014
Address: PO Box 1264 East Harwich,MA 02645 Alt.Tel.No.: 774 353 6902
*Per M.G.L.c.147,s. 57-61, security work requires D:part, ent of Public Safety"S"License: Email:scottmorris@sdmelectric.com
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re-
quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.