HomeMy WebLinkAboutBLDE-21-002257 (2) Commonwealth of Massachusetts OfficialciUse Only
Permit No. ( —2ZS9
.t �_ Department of Fire Services
„=__I= ,7 Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.
°' �� 1/07] (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 10/23/20 Job # 21818
City or Town of: Yarmouth To the Inspector of Wires:
By this application the undersign
Location(Street&Number): 131 Ansel Ballet Road
Owner or Tenant: UPS Telephone No.
Owner's Address Same
Is this permit in conjunction with a building permit? Yes ❑ No 17i (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead n Undgrd n No.of Meters
New Service Amps / Volts Overhead n Undgrd n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Install power wiring and lighting for extension of
Conveyor system.
Completion of the following table may be waived by the Inspector of Wires.
No.of Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
AboveIn- No.of Emergency Lighting
No. of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No.of Switches No.of Gas Burners Initiating Devices
No.of Air Cond. Total No.of Alerting Devices
No.of Ranges Tons
No.of Waste Disposers HeatPump Number Tons KW No.of Self-Contained
Detection/Alerting Devices
Municipal
No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other
Heating Appliances KW Security Systems:*
No.of Dryers No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No. of Motors Total HP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work $- 100,000.00 (When required by municipal policy.)
Work to Start Inspections 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 ® BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Renaud Electric&Communications Inc. LIC.NO.: A-17459
Licensee: Thomas Renaud Signature LIC.NO.: E-24023
(If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 508-865-1300
Address: 18 Providence Road PO Box 36 Sutton Ma.01590 Alt.Tel.No.: 508-865-3513
Per M.G.L.c 147,s 57-61,security work requires Department of Public Safety"S" License Lic SS-0026Q7
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 agent.
Owner/Agent Telephone No. PERMIT FEE: $ 500.00
Signature