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Home My WebLink AboutBLDE-22-001066 op Commonwealth of Official Use Only '4. , Massachusetts St Permit No. BLDE-22-001066 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:8/24/2021 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) 340 ROUTE 6A Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address FIRE DEPT, 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: Data/Comm cablin• 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 O /,i A No.of Luminaires SwimZersT ng Pool ❑ I ❑gnd.No.of Receptacle Outlets No.oFIRE ALA' al a No.of Switches No.of Gas Burners No.of Detection a• . O Initiofine Total Deng D D No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 4P 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 ❑ Ot • :O Connection No.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: 8 Heaters Siens 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 of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 RECEIVED rA116 20 2021 / BUILDING Permit No.DEP/11[0ENT Comnwntuoalth s i/addac�iaestle Official Use Only BY ---- �J1 Q 64 11,.1.:ii , - 2epariimsnl oi.}iee Serviced 1' r Occupancy and Fee Checked rBOARD OF FIRE PREVENTION REGULATIONS 1/4 (Rev. l/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: re �d J/ City or Town of: YARMOUTH To the Inspe or f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 3Yd /r 4,11 yhenwr// *'z Owner or Tenant 7j,0 of (/ X17/ Telephone No. , )/ 1 Owner's Address //%L Ar �Jp n,f777 yAvivhdril Is this permit in conjunction with a building permit? Yes 0 No 0r- (Check Appropriate Box) Purpose of Building �1xe S'T rn/ Utility Authorization No. Existing Service .94 Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service 44 Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampadty ,(/1/l Location and Nature of Proposed Electrical Work: xe 77�I,.i.... n 3L ` A ,,-77,,, cdsiel'' 2 e�,rngu t , tilt' tAga7, Completion of the followinktable may be waived by the Inspector of Wires, W No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fans Tof of Traann sformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting grnd. grnd. Battery Units _ `I No.of Receptacle Outlets No.of OU Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and { Initiating Devices I I.! 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/Alerting_Devices No.of Dishwashers Space/Area HeatingKW Municipal P Local❑ Connection 0 ower No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent P No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: sa Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: %94',5,' (When required by municipal policy.) Work to Start: Lie/ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CGE: 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 [W BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of pedury,that the Information on this application is true and complete. FIRM NAME: j re;y/D Aien_ejees LIC.NO.: /t A Licensee: etjilz 2 LzwzzA/( Signature LIC.NO.: ,� . // (If applicable,enter"exempt"in the license number line.) Address: Bus.Tel.No.: ye/ is r7� tS7D Tel.No *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License: Alt.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 ■ owner's a:ent. Owner/Agent Signature Telephone No. PERMIT FEE:5