HomeMy WebLinkAboutBlde-20-002697 Commonwealth of Massachusetts �tcial Use Only
'y _� Department of Fire Services Permit No. �eq
=I+ " BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
°'..av [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: 11/8/19
City or Town of: West 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 674 Rte._28
Owner or Tenant MIG Corp Telephone No. 508-400-8936
Owner's Address One Acton Place -Acton, MA 01720
Is this permit in conjunction with a building permit? Yes❑ No[ (Check Appr : !.
Purpose of Building n/a Utility Authorization No. .. ,,
Existing Service Amps Volts Overhead Undgrd No.o Meters
New Service 100 Amps 120/240 Volts Overhead gi Undgrd No.of Meters
Number of Feeders and Ampacity644‘3.0410 II-
Location and Nature of Proposed Electrical Work: Install 100Amo temooraty service for construction
completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Lighting Outlets No.of Hot Tubs Generators KVA
No.of Lighting Fixtures Swimming Pool Abos� In- No.of Emergency Lighting
grnd. grnd. I I 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 I Number I Tons I KW No.of Self-Contained
Totals: I ""
I Number� - ���� '�-� Detection/AlertingDevices
No.of Dishwashers Space/Area Heating KW Local Municipal Other
Connection l
No.of Dryers Heating Appliances , Security Systems:
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Data Wiring;
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: 11/8/19 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 proof of same to the permit issuing office.
CHECK ONE:[INSURANCE 11E1 BOND 0 OTHER ❑ (Specify:) GENERAL ACCIDENT INS 7/31/20
I certify,under the pains and penalties of perjury,that the information on this application is true and completes (Expiration Date)
FIRM NAME: REILLY ELECTRICAL CONTRACTORS,INC LIC.NO.: 9897A
Licensee: MICHAEL J. MCSHEFFREY Signature
(If applicable,enter"exempt"in the license number line) //1/ LIC.NO.: 9897A
Address: 110 OLD TOWNHOUSE ROAD,SOUTH YARMOUTH,MA 02664 s.Tel.No.: 508-771-2040
0-8936
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability .coverageTel No.: ly required
law. By my signature below,I hereby waive this requirement. I am the(check one) owner insurancelowner's
's gent. normally required by
Owner/Agent ❑owner's agent.
Signature Telephone No. I PERMIT FEIE:$