Loading...
HomeMy WebLinkAboutBLDE-22-001703 Commonwealth of Official Use Only CUMassachusetts Permit No. BLDE-22-001703 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:9/24/2021 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 HIGGINS CROWELL RD 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 ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ 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: Site visit NON ' "• +' CENTER) 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 Tons 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 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 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: DANIEL E DICESARE Licensee: Daniel E Dicesare Signature LIC.NO.: 21275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 ELK RUN, MIDDLEBORO MA 023463065 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 1, titsl 7f .cr 6,/G(A. q 2 q - J M uOfficial Use OnlyOnly , .moruvea.nj ¢cites ua6 -F Permit No. Z -� ZO3 �a ' eprze07teru of."---Ps�epvi.ce: Occu anc; and?ee Checked BOARD OF FIRE PREVENTION REGULATIONS f •_- ev. _r? : .ease‘‘i1. k) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be peo.=,ed is.acco.: ce with Messaddue s�:ec_i l Code EC),527 CAR.12.00 (PLEASE PRINT.LY I OR TYP ALL . _ORI. 270 A) Date: 9//(o'la/ City or Town of: 1 laf/n0 U'1/) To the:inspector©f Wires: By this applicaton the tmderst ed gives-once of his or her ''_ten oil to perform the `leb irk work described below. Location(Street&Number) I3L{a H 3,4./ Ciotti? I i ,.ce ! Owner or Tenant I ��✓ Telephone No. Owner's Address V 4 WV- I _ Is this permit in conjunction with a build permit? Yes - No - (Check Appropriate Box) Purpose of Building ; Utility,-Authorization No. Existing Service Arms I Volts D-Faritea ._ lind•?- No.of Meters New Service Amps Volts Overhead_ adg d - No.of Meters Number of Feeders and Ampacity . //�� S — Location and Nature of Proposed Electrical Work: Lc/7C V I J/ 7 Com..ie:on cr to foilor in :able Ye1 be waived b the 7rS e.cior 0 f Vfirei. otal INo.of Recessed LnTni�aires !",.No.of Cam.-Srsp.('Paddle)Fans. No.of;Transformers KVA _ A No.of Luminaire Outlets 1No.of Hot Tubs C-enerators KVA Ii Above — In- !No.of. .rnergency Log tnrig ldo.of Li*�;ngrres Sw crniag Pool ai s. mod. — ;Battery Units � a.of Receptacle Outlets i `•.No.of Oil Burners =FIRE ALARMS ,.of 7 es Iio.of Burgers =No.of Detection and No.of Switches Initi ine Devices Total No.of Ranges !No.of Air Cond. Tons ?No.of Aleriiag Devices Heat Pump;lumber !TOW KW iNo.of Self-Container! 4No.of Waste Disposers I Tom:: iDetectioniAiertina Devices {No.of Dishwashers `Space!A.rea Heating KW ILoeal L Coonnectio un _ Other o.of Dryers :Heating Appliances ri Security Systems:* No.of Devices or Equivalent 1lo.of Water No.of No.of pats Wiring: Heaters Sites Bo'•�� s No.of Devices or Equivalent v.._..,_a _ Telscoramunications Wiring Na.Hydromassage Bathtubs ?No.of Motors i.oral HP \o_of DEViCes or Euur.a<en. !OTHER: ach.a ±cor:al derail if b.'esirm,..',or as required by the f7 n ec or of Wires _Estimated Value of deco icai W o:c ,.v r_eri r- 3.±eti.by ri n oisal poky; Work to Sta_ri li.speczo s to be.r Tested in accordance with N=C Rule IC,and upon corns efo . INSURANCE COVERAGE: Unless waived by the ov•ner,no perrnit for the 1e cr'nce of ececaI work may issue unless the licensee provides proof of liability insurance in..._ g"completed coe a on"coverage or its suBs?2sztial equivalent The de':sigled w'ri� es that suchi co' a is ir.force,and has exhibited c:oof of same to The permit issue office. CPECK ONE: INSURA4NCE VI BON O"'-.r (sDec=ry:) I certify,under the pains andpeazal of oerfur',:,_ar the iii orriz .or on his aalJlcadon Ls true and cornplo, FIRM NAME: a e_i_e c c.-;. !I,( LIC.NO.:. i A 1 n � ri Licensee: a.1:;%EL E, 5 C ,A c e S=gnatu y.f...:,71.. f a/...��.-K LIC.NO. }; b� l aRciivzbie,enter" .:emot"jzithe I==rse w:der ire.; Bus.Tel.NC.: )t; r "r=,_ Address: ; EL ect.A.7 A.1=MU.it.�c 1i->< 3 y C - — it.Tel.No.:_ _... '*Per M.G.L.c.147.s.5 7-61,sec r_ty work e requites Deo—_at of bb_c Sae S`-icefse: �ic.'o. C t 3:2 OWNER'S INSURANCE StAIVER I am aware that the L^wee:ices nor rza;;e the liability iinsurw cove no:mai:L required by law. By r y 57.z:re below,-:e. by waive this- _ _.ems... .as:the ob. k ore)7 owuc: _j ov,ner's aver Owner/Agent ut� e ;eiE7)Lot:e No. f PERMIT P.trE: S 0