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Home My WebLink AboutBlde-21-006705 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-21-006705 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:5/19/2021 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 electncal 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: Install additional receptacle in 2nd floor hallway. 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 1 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 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 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 6-063. 6(--A fiLk Commonweal h o`Mathieu/was Official Use Only _ eB+', _ '~ / "[Japan�aranE o/.. ire Permit No. /� ?O S Fa Services v ccucy and Fee Checked �� ;~ BOARD OF FIRE PREVENTION REGULATIONS1/4 [ROev. 1pan/07) (lCave 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://4- 2 't/ City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice ofbis o 'i. o perform the electrical work described below. Location(Street&Number) //4/ f /'. Owner or Tenant ZI.J_7t.1 fp, " , Q—i4.1 Telephone No.,�/jje'Z f Owner's Address l, 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❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead ,Undgrd 0 No.of Meters Number of Feeders and Ampacity ,�s/ Location and Nature of Proposed Electrical Work: d/ pow zee, e ,gx, my Completion of thefollowinktable -m be valved by the Inspector of Wires. tli No.of Recessed Luminaires No.of Cdl.-Sasp.(Paddle)Fans No.of Total Transformers KVA C. No.of Luminaire Outlets No.of Hot Tubs Generators KVA -t:' No.of Luminaires Swimming Pool Above ❑ grnd. ❑ Batte UnitsEmergency Pro.of Lighting 1 No.of Receptacle Outlets / No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 'No.of Detection and 114 No.of Ranges Total Initiating Devices g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number IRAs W No.of Self-Contained ' Totals: I`` _..__.___.___.. Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local Municipal❑ Connection ❑ ate' No.of Dryers Heating Appliances KW Security Systems:4 No.of Water No.of Devices or Equivalent No.of No.of Heaters �' Signs Ballasts Data Wiring: ' No.of Devices or Equivalent No.Aydromaasage 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; j/ /7 `I/ 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 0 BONDO, OTHER :) I certify,under the pains and naldes o 0 n on J'pedury,that the information on this application is true and complete. FIRM NAME: 734..A.1 a/ y 1J.rUy �l'�7Q ( 4A...) Si !� LIC.NO.: Licensee: gnatur , :..." LIC.NO.:E.3 q (If applicable,enter"exempt":a he license number_`4 Address: 7 / .�7 Bus.TeL No.:�D *Per M.G.L.c. 147,s.57 U� � Alt.Tel.No.: security work requires Department of Olubis Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one 111 owner ■ owner's a:ent. Owner/Agent Signature Telephone No. PERMIT FEE:$