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Home My WebLink AboutBLDE-22-000275 (2) or Commonwealth of ` Official Use Only set SI Massachusetts BLDE-22-000275 "^' Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev.I/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) /16/2021 City or Town of: YARMOUTH Date:To the Inspector By this application the undersigned gives notice of is or her intention to perform t e electrica work described below. of Wires: Location(Street&Number) 340 HIGGINS CROWELL RD Owner or Tenant TOWN OF YARMOUTH Owner's Address 1146 ROUTE 28, SOH YARMOUTH, MA 02664-4463 Telephone No.UT Is this permit in conjunction with a building permit? Purpose of Building Yes 0 No 0 (Check Appropriate Box) Existing Service Amps Utility Authorization No. New ServiceAmps Volts Overhead ❑ Undgrd 0 No.of Mete rsVolts Overhead 0 Number of Feeders and Ampacity Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: Emer enc repairs for si n li ht dams ed b contractor. No.of Recessed Luminaires Completion of the following table may be waived by the Inspector of Wires. No.of Ceil:Susp.(Paddle)Fans No.of No.of Luminaire Outlets Trans rmers Total No.of Hot Tubs KVA No.of Luminaires Generators KVA Swimming Pool Above In- rnd. ❑ 'rid. ID No.of Emergency Lighting No.of Receptacle Outlets Batter n't No.of Oil Burners No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Ranges No.of Air Cond. Total Initiati . De is• No.of Waste Disposers Heat PumpTons No.of Alerting Devices Number Tons T tals: -®No.of Self-Contained No.of Dishwashers -D•tecti i n/Ater 'n' I evi e Space/Area Heating KW No.of Dryers Local 0 Municipal 0 Other: Heating Appliances 'nne tion No.of Water KW Security Systems:* Heater KW No.of No. f evi •s or E uivalent i I.n No.of Ballasts Data Wiring: No.Hydromassage Bathtubs No. i f Device i r E i uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.o Devi es or E, ivale.t Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. Work to start: (When required by municipal policy.) Insp n ectio 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 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. provides CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: TYLER W PAYNE Licensee: Tyler W Payne Signature (If applicable,enter"exempt"in the license number line.) M.Tel.No.: Address:5 JANS PATH, HARWICH MA 026452458 LIC.NO.: 22091 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safe OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my Alt.Tel.No.: signature below,I hereby waive this requirement.I am the(check one Owner/Agent ) ❑ owner 0 owner's agent. Signature Telephone No. PERMIT FEE:$80.00 at ki 7/1 qter vt_, -- Official Use Onl Commonwealth of Massachusetts 1 = f O�z7s 1 _ Department of Fire Services Permit No. �,, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked '�'�' [Rev.9/051 (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: r'llivIg I City or Town of: \kw nr\OLAAii, . To the Inspector of Wires: By this application the undersigned gives notice of his or her iOtbt(i ntion to perform the ele'trical work described below. Location(Street&Number) 3LtO l 'c1;tinS ad , V61ieaOwner or Tenant i /- j�. Telephone No."17g-a) 'qj)_ Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Pc IA CC Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wiles. 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. Batter 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 Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number l Tons f I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Municipal _ Local❑ Connection � Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Ele trical Work: (When required by municipal policy.) Work to Start: `71(562 I Inspections to be requested in accordance with MEC Rule 10,and upon ion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electricalworks may issue 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 Z BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties o l�1f perjury,that the information on this application is true and complete. FIRM NAME:?A\ NE ELEC R% Licensee: T1(�VZ W LIC.NO.:3 y NE Signature t LIC.NO.22. (If applicable,enter "exempt"in the license number line.) �(A' Address: P.O. BOX toi ti JOUT H il I�v 10-k tit 07 ( D I Bus.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here:No.: :Z2. 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) 0 owner ❑owner's a:ent. Owner/Agent Signature Telephone No. PERMIT FEE:$