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HomeMy WebLinkAboutBLDE-22-005467 Commonwealth of Official Use Only E114A‘ Massachusetts Permit No. BLDE-22-005467 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:3/29/2022 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) 938 ROUTE 6A Owner or Tenant 011ie Orman, LLC Telephone No. .,-4-------____�' U � Owner's Address 938 MAIN ST,YARMOUTH PORT, MA 02675-2172 YLSc)V Is this permit in conjunction with a building permit? Yes 0 No ❑ heck Appro late Box) Purpose of Building Utility Authorizati No. �9 /53 Existing Service Amps Volts Overhead 0 Undgr CI No.of Me(ers New Service 400 Amps Volts Overhead 0 Undgr El No.of Meters Number of Feeders and Ampacity , Location and Nature of Proposed Electrical Work: Install 400 amp meter bank 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 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices 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 Ballasts Data Wiring: Heaters Siens 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 F THIBEAULT Licensee: Robert F Thibeault Signature LIC.NO.: 22475 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:36 GOVENOR BRADFORD RD, BREWSTER MA 026312806 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: $200.00 --,7;r--eirte4 61101611.— n IIALX mN )A- CC 3)30[2(z- rRECEIVED � rru a�5ae�ucse Oeial UseOnAR 25 2022 ,. _„ ::11� - .2. ar{.mrr o{.-ira Jcr.-4.6Pelm[tNo.ING DEPARTME =r :. , POccIIpancy and Fee Checked� _ .' BOARD OF FIRE PREVENTION REGULATIONS TRev. 1/D7] (leave blank) —� APPLICATION FOR=PERM[T TO PERFORM ELECTRICAL WORK AI work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C1via 12_D0 (PLEASE PRINT IN OR TYPE ALL INFORMATION) Date:__ '3 z Q nqr 6/_ City or Town of: YARMOUTH To the Inspector of Wires: . - By this application the yndersi�red ewes notice of his or her intention to perform the electrical wort:described below. Cr Location (Street&Number) 6 0. . L OZ _ Owner•orTenant /"� 1 j 1 Telephone No. Owners Address G /. A I. II a r r V ' 02-Le Is this permit in conjunction with a building permit? Yes 2 No�❑ (Check Appropriate Box) . Purpose of Building - — Utility Arthorization No. Existing Service -- Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service 4 DO Amps 4.210/ {Felts Overhead ❑ Undgrd 23 No.of Meters Number of Feeders and Ampacity ( ) ,v,©0 Location and Nature of Proposed Electrical Work.: sLa__ /l :,rb CarrzpLetion of the fotlawinQ ...le may be weved by the Inspector or Wires. No. of Recessed LzznTrroTres IND of Cell-Rasp.(Paddle)Fags No.of Total Transformers gV4 No. of Luminaire Outlerts No.'of Hot Tubs Generators KVA - No. of Luminaires 5v,irnmiag Pool Above ❑ la- 0 6-o.or4.merg_ncy .Tang grad., orad_ ary IIaits No. of Receptacle Outlet No. of OE Burners !FRE ALARMS No. of Zones Na of Switches iNo_of Detection and IND.of Gas Burners No. of Ranges Total Devices No. of Air Cond. Tons IND.of Alerting Devices No.of Waste Disposers IHeatTotPuamls:p I Number Tons KW No. of Setf-Contain-ed I �Detection/4lerting Devices No. of Dishwashers S ace/Area Heating KW' Mttaieipal p 1'0�Q Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* NO.Of No. of WHeaters KW INo. of ater No. of Data Wiring: Devices or Equivalent Signs Ballasts Na of Devices or Equivalent ` No. Hydromassage Bathtubs No. of Motors Total AP (Telecommunications Wiring 1 No.of Devices or Equivalent OTAFR: Attach additional rlptriltf derired or as required the Estimated Value of Electrical Work: _ by Inspector of fres. (When required by municipal policy.) Work to Start: 3;„2„.5,2,Q2a 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 BOND ❑ OTHER 0 (Specify) CO/n11--e7-02_ 2 ,P -, I certify, under the proms and penalties ofperjury,that the information on this application is true and coerplete. FIRM NAME: s --1--, 'Ay,' 0 : f 'C LIC NO.:_E= Z, Licensee: 7 --7- i`,,e.0,.t; l Signature� 2 ? LIC.NO.: (If applicable, enter "ecernpr"in the license number line) Bus.Tei.No: 3- Address _ . a z r''I, . .....4' ado : B _ '(.o I Alt Tel.No.: ,I 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 5 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. I PERMIT FEE: $ I