HomeMy WebLinkAboutBlde-21-001968 or Commonwealth of Official Use Only
E`. 14:1 Massachusetts Permit No. BLDE-21-001968
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•10/14/2020
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) 343 ROUTE 28 UNIT 100
Owner or Tenant HYNES JOHN J JR TR Telephone No.
Owner's Address THE 343 HOLDING TRUST,822 ROUTE 28,SOUTH YARMOUTH, MA 02664 0 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap o' ///Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd CI �� ,� '. 41) J
New Service Amps Volts Overhead 0 Undgrd 0 No.' Itj e •rQ I , ��
Number of Feeders and Ampacity ',
Location and Nature of Proposed Electrical Work: Upgrade lighting.
Completion of the following table may be waived by the .`4 ires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of To
_, Transformers KVA „_-
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad. 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/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 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 BONE) 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: Paul M Morris
Licensee: Paul M Morris Signature LIC.NO.: 17520
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:PO BOX 213,1 COUNTRY WAY,SAGAMORE MA 025610213 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:$80.00
_ Commonwea/h of�Jasaacl,.aaetfs Official Use Only //��
I. " •i cc�� cc77 Permit No. E C�--'L Q,CO V
4 i T epartnwnt o/..71re Serviced
r t cl Occupancy and Fee Checked
,,1' 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: 10 (-1 f — uo
City or Town of:Lpra� To the Inspector of Wires:
By this application the undersign gives noti a of his or her intention to perform the electrical work described below.
Location(Street&Number) 11--2) +"( CS
n
Owner or Tenant --T� /H Telephone No. 1 ,....-
Owner's Address I 3 P.(+7 ,, 47 C<".
Is this permit in conjunction with a b ding permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 _Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: iV Qla,�+L (J�Q,e� lA 'A .1
T
•
Completion of the following.table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No..of Luminaires Pool swimmingAbove In- No.of Emergency Lighting
grnd. ❑ grnd. 0 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 AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number,. Tons KW No.of Self-Contained
Totals: ""_" M. Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of No.of Devices or Equivalent
KW 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: A Z Inspections tt ►e requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERA : 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 J BOND 0 OTHER 0 (Specify:) ,
I certify,under t pains and penalties of perfury,that the information on this application is true and complete.
FIRM NAME: { E't L.L C....i ,.1-1)�, LIC.NO.:
Licensee:?ALA-i Ill p t ,--j-S Signature`*4 , LIC.NO.: /1S24)A—
(If applicabl nter"exempt"in the license number line.) Bus.Tel.No.:
Address: Obi X .2 /3 SA-411-H,la i .t #1* h 2 ill Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public 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)❑owner 0 owner's age t.
Owner/Agent
Signature Telephone No. PERMIT FEE: $ O.
?Al 011.2,1a-1 % se Coit r4-4, Ag-t
s
7