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HomeMy WebLinkAboutBLDE-21-001672 Commonwealth of Official Use Only ifi . Massachusetts Permit No. BLDE-21-001672 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:10/1/2020 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) 484 STATION AVE Owner or Tenant LINEAR RETAIL YARMOUTH#1 LLC Telephone No. 1 /7 Owner's Address 5 BURLINGTON WOODS DR, BURLINGTON, MA 01803 44 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check AA• • : .x) Purpose of Building Utility Authorization No. ` _ Existing Service Amps Volts Overhead 0 Undgrd 0 4 ' ":errjA New Service Amps Volts Overhead 0 Undgrd 0 ,zt, 407 h _ Number of Feeders and Ampacity ,, 'r ,:, Location and Nature of Proposed Electrical Work: Replace 19 pole lights. Completion of the following table may be waived by .r . of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires 19 Swimming Pool Above 0 In- o No.of Emergency Lighting grnd. 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 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 ❑ 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 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: Timothy C Moisao Licensee: Timothy C Moisao Signature LIC.NO.: 14519 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 17 Davis St,Cumberland RI 028647832 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 , Official Use Only . _ �nu�wnwoa[th o`Maeeac�ffe �� t -1 �j^// '' '' c7� cc77 Permit No. Ul ` / ., '� 2epartnunt of ire-gervu:ee if Occupancy and Fee Checked 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: /Q,f/ao City or Town of: YARMOUTH To the Inspect r of Wires: By this application the undersigned gives notice of is or her intention to perform the electrical work described below. Location(Street&Number) y g 4/ 5 M,4-i0 h five V l° Owner or Tenant L t n em-e- A t i I Ytx t v„,,tti 4-k#2 t LCTelephone No. 7 Q/-9t T-6 p1 ad Owner's Address • Is this permit in conjunction with a buildingrmit?j � Yes 0 No [ (Check Appropriate Box) , T l mul , Purpose of Building COe ('G rc�R e to, l Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters )Vew Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters ' * Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: © :01 - e ia e /- a t5 i d e 1-:-.. s d et adP Dle c v� Completion of thefollowin&table my be waived by the I pecfor of Wires. Total No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Tof Transformers KVA nNo.of Luminaire Outlets No.of Hot Tubs Generators KVA st No.of Luminaires .Pool Above ❑ In- ❑ Ivo.of Emergency Lighting i. gird. 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 Z Initiating Devices Tota 111 No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 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❑ Munidponnection al 0 Olber C 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: 0 C 0 0o Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El al Work: to W(When required by municipal policy.) Work to Start: I Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: 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 cortage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCELE BOND 0 OTHER ❑ (Specify:) I certify,under the pijms and palsies of perjury,that the in atlon on this application is true and complete. FIRM NAME: / Y►z 0) /19 t re- oil A LIC.NO.: Licensee: d r 51t(2___Signature - LIC.NO.: (If applicable,enter"exempt"i the license number line.) Bus.TeL No. 110 l"S6 q-!q a 3 Address: 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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$