HomeMy WebLinkAboutBLDE-21-006363 #3 Commonwealth of Official Use Only
"f1-:-.. `:\ Massachusetts
Permit No. BLDE-21-006363
- 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:5/4/2021
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) 1292 ROUTE 28 UNIT 3
Owner or Tenant THE OLD TIME HOCKEY RLTY TRUST Telephone No.
Owner's Address CIO STEVEN ANZUONI TR, P 0 BOX 1178, SAGAMORE BEACH, MA 02562-1178
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: Upgrade lighting(FAIRWAY FINANCIAL)
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 C KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emer••nc
Agrnd. grnd. Battery Un
illo - 3724"
No.of Receptacle Outlets No.of Oil Burners FIRE AL ‘0.)
I •0
No.of Switches No.of Gas Burners No.of Detectio Initiative Devices /� ip,
No.of Ranges No.of Air Cond. ons TotNo.of Alerting Devices U 0
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 0 Municipal ❑ O
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 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
C oassnoxarsai k o/fPIadsacltueoff` O chi Use Only
V eparkaant a/
-gawked Permit No.
40
OXY
-< BOARD OF FIRE PREVENTION andFoeChedo
REVENTI td REGULATIONS [Rev.UO?I (leave mac)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he maimed in accordance with the Massachusetts Flleelrleal Code ,527 I' 12.00
C'LEAS'EPRJIVTTININ OR TYPE ALL INFOR ATIONJ Date: ZG-,L -) Z I
City or Town o U.�`v To t Inspector i f i es:
By this applitetiontheun notice ofhis or ha-intention to peribun the electrical work described below
Location(Street ) - [ -'2u E f
Owner or Tenant � n \
��'-' LA.�L1 .� (�--i1 C�i�f Telephone No. 137),s 5
Owner's Address ). 1 M 5 D k 1 y a 1 } % 3 7
Is this permit in conjunction with a building permit? . Yes Lj No 0 (Cheek Appropriate Box)
Purpose of Building - Utility Authorization No.
-- --- Amps . I Yobs Overhead 0 Undgrd❑ Na of Meters
New Service Amps 1 Volts Overhead❑ Undgrd 0 No.of Meters
.'Number of Feeders and Ampaciy ft
Loeath m and Nature of Proposed EIectsicaI Work .Qilb-t'-z- t�1�'Y 0-11-1 rad I`"
No. ci
of Recessed No.of Completion glthe lbllowb be waived by the Inspectorefwiras
C (Paddle)Fees :Transformers TToia
No.of LOutlets No.of Rot Tubs Generators • KVA .
lYo.of Unalaska sainuning Pod Above 0 in-
s �cYuguunr.
•
No.of Ra Outlets No.of 011 Burners FIRE ALARMS No.of Zones
No.of Ssvitehos No.of Gas Burners . NDaand
wes
No.of Ranges No.of Air Gond. ' Tota[ A
Tom No.ofAlertlng Devices
No.of Waste Disposers �T �N IT,��KW- Self-Contained
No.of Dishwashers Space/AreaKW - 1i• ---y
Local 0 d, ,a 0 Other
No.of Dryers . Mathis Appliances KW Security . _ '
o.o Water No.a.[ 1 - �- or Equivalent . -
Heaters KW No.Signs No.
of Data Ballasts
No.offWiring:
or uivalent
No.aydrornassage Bathtubs No.of Motors Total IIP Telecommaetea s 1 ,,,
OTHER: No.ofDevices or •- i , -,t
Estiurattxl Value _ Attach earnwtal etal7 ffd red oras required by the Inspector of Witte
o£Blect icat Work:- (When required by municipal policy.)
Work to Start pt- Inspections in accordance with MEC Rale 10,and upon completion.
INSURANCE COVERAGE:.Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee pollices pro fof liability insurance including"cortyleted operation"coverage or its substantial equivalent The
underaigngdreertiSes that such coverage is in*ace,and has exhibited proof of same to the permit issuing office.
•
CHECK ONE: INSURANCE jg BOND ❑ OTHER 0 (Specify) ,
if FIRMr(NAME: f ian dce,, `�f 'that the information on this appilaatlon iso and complete
ll c.--/` •c..... -' LTC NQ:
Licensee: / nft o,,s-.."-/-41 Signature .. LIC.NO.:115A
(Ifapplicabl ester u "hrthelicenaenumberline.) Bus.Tel.No.;
•
Address: 1 g a/3 Tif -It, $ Ai it- it 21 J Alt Tel.No.:
•
*Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"Ligase: Lic.No. .
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurancecoverage normally
required by law. By my signature below,Thereby waive this sequfement I am the(check one)El owner 0 owner's agent
Owner/Agent
Signature Telephone No. IPRRMTI'FEE:$ Ca 0-w
p fir R-10-04";-4. f Ciuto ns-di ata-