HomeMy WebLinkAboutBlde-21-002341 Commonwealth of Official Use Only
CIL"
Massachusetts
Permit No. BLDE-21-002341
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:10/28/2020
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) 6 LOCUST ST ,ottp(I,
Owner or Tenant WRZESINSKI Telephone No.
Owner's Address O s
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check 4,;1,:w
z,
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of •1004? ok
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install security&fire systems. 46
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 0 In- ❑ No.of Emergency Lighting
grnd. grnd. Batten,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 5
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices 5
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 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:* 4
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: 1
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 K Boucher
Licensee: Robert K Boucher Signature LIC.NO.: 1317
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:218 SETUCKET RD,YARMOUTH PORT MA 026752258 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:$45.00
Commonwealth of Massachusetts OfficialUse Only
i`+ '- � Department of Fire Services Permit No.
_C_6_ " Occupancy and Fee Checked
,_� --' BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: 10/25/20
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) 6 Locust Street,S.Yarmouth
Owner or Tenant Wrzesinski Residence Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes No X (Check Appropriate Box)
Purpose of Building 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
Location and Nature of Proposed Electrical Work: Install low voltage security and fire alarm.
Completion of the following table may be waived by the Inspector of Wires.
NoNo.of Recessed Luminaires No.of CeiL Tr
-Susp.(Paddle)Fans 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 1
No.of Switches No.of Gas Burners No.of Detection and 5
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting
Devices 5
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 ❑
Connection Other
No.of Dryers Heating Appliances KW Security Systems:* 4
No.of Devices or Equivalent
No.of Water No.of No.of
KW
Heaters Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications W'�ring: 1
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 2k (When required by municipal policy.)
Work to Start: 10/20 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 X BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this appli ation is true and complete
FIRM NAME: Seaside Alarms inc. L C.NO.: 1317C
Licensee: Robert K.Boucher Signature i�j LIC.NO.:
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 508-394-0599
Address: 1265 Route 28,South Yarmouth,MA 02664 Alt.TeL No.:
*Security System Contractor License required for this work;if applicable,enter the license number here: S-0046
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)❑owner 0 owner's agent.
Owner/Agent I
Signature Telephone No. I PERMIT FEE: $
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