HomeMy WebLinkAboutBLDE-21-002257 \ Commonwealth of Official Use Only
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�.- Massachusetts Permit No. BLDE-21-002257
BOARD OF FIRE PREVENTION REGULATIONS Occupancyand Fee Checked cked
[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)
City or Town of: YARMOUTH Date:To the Inspec2020
toBy this application the undersigned gives notice of his or her intention to perform the electrical work described below.r of Wires:
Location(Street&Number) 131 ANSEL HALLET RD
Owner or Tenant ROSEREAL CORPORATION
Telephone
Owner's Address %NEWBANY CORP ATTN:TAX DEPT, PO BOX 28606,ATLANTA,GA 30358-06 60
Is this permit in conjunction with a building permit?
Purpose of Building Yes 0 No 0 (Check Appropriate Box)
Existing Service Utility Authorization No.
New ee Amps _ Volts Overhead ❑ Undgrd 0 �jt7, ,
Amps Voltseters
Number of Feeders and Ampacity Overhead 0 Undgrd z �'
s
46f
Location and Nature of Proposed Electrical Work: Power&lighting for extension of conveyor sy :., `
y
Completion of the following table m� .''
b..
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of th Spector of Wires.
Transformers Total
No.of Luminaire Outlets No.of Hot Tubs A
Generators KVA
No.of Luminaires SwimmingPool Above In-
rnd. ❑ rnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets No. Batte Units
of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners
No.of Detection and
No.of Ranges Initiatin Devices
No.of Air Cond. Total
Tons No.of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: -
No.of Dishwashers Detection/Alertin. Devices
Space/Area Heating KW Local 0 Municipal
No.of Dryers Connection ❑ Other:
Heating Appliances KW Security Systems:*
No.of Water KW No.of No.of Devices or E•uivalent
Heaters Si ns No.of Data Wiring:
Ballasts No.of Devices or E s uivalent
No.Hydromassage Bathtubs
No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or E s uivalent
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.)
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 ',Pea
:)
I certify,under the pains and penalties operjury,that the informationR ❑on this application true andR '" ,r !
FIRM NAME: THOMAS H RENAUD pp ®� `�� `�
complete. i�
Licensee: Thomas H Renaud
(If applicable,enter'exempt"in the license number line) Signature LIC.NO.: 17459
Address:18 PROVIDENCE RD, SUTTON MA 015903813 M.Tel.No.:
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
Owner/Agent ) 0 owner 0 owner's agent.
Signature
Telephone No. PERMIT FEE:$500.00
'Th0,77 A--c_ 3A1/2,-/ ICE-,