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Home My WebLink AboutBlde-19-002170 0 Commonwealth of Official Use Only Permit No. BLDE-19-002170 al% 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:10/11/2018 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) 340 HIGGINS CROWELL RD 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 App`y� te Box) Purpose of Building Utility Authorization No. / JJ Existing Service Amps Volts Overhead 0 Undgrd 0 of:', / New Service Amps Volts Overhead 0 Undgrd 0 s to Number of Feeders and Ampacity di IteLocation and Nature of Proposed Electrical Work: Receptacles for washer&dryer. O Completion of the,following table may be ee e of Wires. Y No.of Recessed Luminaires No.of Ceil: No.of otal Susp.(Paddle)Fans Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators o A No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 1 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 0 Other: Connection No.of Dryers 1 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.: 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $0.00 l..ommenweaifh of 7l addachadetta aI se Only F c c Permit No. �V' - �(7 o 41. 2spartnunt o f a°ira Serviced BOARD OF FIRE PREVENTION REGULATIONS [Rev. l,'07]Occupancy an bt nk}ked t 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 WFORMITION) Date: City or Town of: 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) 3 yQ / 5's /4,G-/7 // r�o4,. ej✓if�i�dl}vtdv Owner or Tenant y/y/f ftp.//, :P__//Ce. 1 1?17. — Telephone No. Owner's Address _ • Is this permit in conjunction with a building permit? Yes C No (Check Appropriate Box) , Purpose of Building /, ,7fd1 5' Utility Authorization No. Existing Service/ppp Amps /ZOi t Vc Volts Overhead n Undgrd Li No.of Meters New Service Amps 1 Volts Overhead❑ Undgrd C No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 4/77-S�/^/!. 70 , ' 0 L}7/i7- Completion of the followin table may be waived by the Inspector of Wires. „, .ofNo.of Recessed Lu n miaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Na.of Luminaires Swimming Pool Above r—i In- ❑ No.of Emergency Lighting ggrnd. 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 Ran es No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-contained p Totals: '"u u` Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipai ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* i 3 No.of Devices or Equivalent NO.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H-dromassa a Bathtubs No.of Motors Total HP Telecommunications Deviations Wiring: y g 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: /0 —//`//— 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 iOND ❑ OTHER D. (Specify:) I certify,under they_ains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: / / / /T7`e..S' Iii.l rti i',,rN� LIC.NO.: (,} Licensee:QO 41,74 (>9/7 lsa� SignatureCam'`-c� !LIC.NO.: E-, r�g' 4 / (If applicable,enter "exempt"in the license ma er 1ipe.) kS�t7s.Tel.No.' Address: SD 7 (/CA-' _/5/ f+/� 44 Alt.Tel.No.: 2 S 7' 4 X7 a *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$