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Home My WebLink AboutBLDE-22-005104 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-005104 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:3/15/2022 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) 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 new circuit to Channel 16 room. 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 Initiating Devices No.of Ranges No.of Air Cond. To 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 0 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 Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent 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.: 16945 (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 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: $0.00 3flc1�4 i ACommonavea(tb modach.th Official Use Only da Zeivarintent o`. ire,Serviced Permit No. 7.----2--- l 0 • ;— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] (leave blank) 1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASEPRINT IN INK ORTYPE INFORMATION) Date: '� --n — .2- .__..______Z---- City or Town of: .,: ARMQUTH To the Inspector ofWires: '3y this application the undersigned gives notice of his or h intention to P Location(Street&Number) / 6 4T- Z_ perform the electrical work described below. Owner or Tenant /9-//Owner'r Address "., Telephone No. rimer / Is this permit In conjunction with a buU �/�1t? Yes 0 No 1E1- (Check Appropriate Box) Nose of Building it/ /5','9 Utility Authorization No. !slating Service _ Amps / 7 alts Overhead iNggkeas 0 Undgrd 0 No.of Meters _ Amps / Volts Overhead 0 Undgrd Number of Feeders and Ampacity g ❑ No.of Meters Location and Nature of Proposed Electrical Work: C / lG "Pa e, tb V Com letlon, Na of Recessed Luminaires the ouowi _ tab!e m, be waived, the In . for o Wires. �J Na of Cell.-Snap.(Paddle)Fans `o.o ata No.of Luminaire Outlets Transformers KVA No,of Hot Tubs Generators KVA 4' No.of Luminaires Swimming Pool 4 ' Ve ❑ a- o. Units cy ' " o.o[lReoeptade Owlets d. ❑ Bettee Unita ng ,,` / No.of OO Burners No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners 'a o a^- , Ara' , v. I 1.+ No.of Ranges Inidadn Devices Na of Air Cond. o' Tons No.of Alerting Devices a of Waste Disposers '�oto ,'um, r ons ' '• 'O.o .r, on:I n_, NO.a of Dishwashers �Mon ---- Detection/Alertin Devices Space/Area Heating KW Local❑ 'un rtt1 Na of Dryers Connection ❑ Other a o , rHeating Appliances KW . ., y .,, : o.o No.of Devices or • ,trivalent neaten KW o.o Data S,_ ,a Ballasts Na off Wiring: No.Hydromassage Bathtubs No.of Motors Total HP e ecommue or , _ gg trivalent OTHER: 42 of Devices or • ,trivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Stag: (When required by municipal policy.) (When to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the the;licensee provides proof of liability "completed performance of electrical work may issue unless insurance including 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 p,3fnc and penalties of perju ,that the Informetto, on FIRM NAME: ./#i / J , ' /jov" e---, "I' licadon is true and complete Licensee: �i � LIC.NO.: !�- �� -/� ' !s �' afore. 1,74,1%."--%/0110P.7— LIC.NO.: (` LiMnsee: , ter f"in the license num, line) �-J" Address: 1Bus.TeL No.. *Per M.O.L.c. 147,s.57-61,securitywork �r �� requires Department of Public SafetyS"License: Lic.No. Alt.TeL No.: �('// OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally tO required by law. By my signature below,I hereby waive this requirement.Cequireent. 1 am the(check one ■ owner ■ owner's agent. Signature Telephone No.