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HomeMy WebLinkAboutBLDE-21-005861 Official Use Only Commonwealth of fin1Massachusetts Permit No. BLDE-21-005861 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:4/12/2021 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) 124 GERMAN HILL RD Owner or Tenant Verizon Communications Telephone No. Owner's Address 118 Flanders Road,Westborough, MA 01581 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate lqx /1!G �1Ldzi Purpose of Building Utility Authorization No. 5377971 �� Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Overhead LEI Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Service to Verizon communications site. 9 _. O Completion ofthefollow I e mm461-16, , , y • ie for of Wires. P No.� � r'.y. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tr.', '";) p r No.of Luminaire Outlets No.of Hot Tubs 14 Genera Ir SwimmingPool Ab ❑ In- ❑ No.of Emergency L' g i No.of Luminaires grnd.ove grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Z 0 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 Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices 0 Municipal 0 Other: No.of Dishwashers Space/Area Heating KW LocalConnection Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or Equivalent No.of Water KW 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. required bymunicipal policy.) Estimated Value of Electrical Work: (Whenq p p y' 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:) etO 7 _J „,r�l I certify,under the pains and penalties of perjury,that the information on this application is true and complete. ram' t FIRM NAME: Jeffrey L Henley LIC.NO.: 20115 Licensee: Jeffrey L Henley Signature (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:30 BRADFORD ST,WHITMAN MA 023821512 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: $100.00 L ('«(2,1 t Co onweaA o )aioachu�eth Official Use Only ''_ a �( Permit No. e:ZA —� ear o`3-ire cervical ffi t is G, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. (leave blank) a.r,4' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: yfr .2 a.2.1 City or Town of: /,42 tv[ 0 0—r / M A To the Inspector of Tres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. 2 Location(Street&Number) / y � -/e/t4,d-N hi,LL gD Owner or Tenant VEIZ 12-0N VV t / &S Telephone No.gat-3 -S. 3Q Owner's Address k i$ F(AN( $ tjaf?, o--S-rpoti go t16Jd /114. cis et Is this permit in conjunction with a bu' ing permit? Yes ro No ❑ (Check Ap priate Box) Purpose of Building 1 ata:JAi Utility Authorization No. 7 79 7.1 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service �© Amps /2a /24(0 Volts Overhead Undgrd n No.of Meters > Number of Feeders and Ampacity / CAD ( - 2a a•,v' Location and Nature of Proposed Electrical Work: Vgrej 20,, �,,I I,15 air-iihter 1��,v � 71-1616AD 56Z-VICer Completion of the following table may be waived by the Inspector of Wires. - - No.of Recessed Luminaires No.ofCeil.-Susp.(Paddle)Fans No ano KV sformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators •KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad, grad. 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 Ranges No.of Air Cond. Toms No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ MunneMionnicipal ❑ Other Co No.of Dryers Heating Appliances KW Security Syystems:* 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 TelecommunicationsDvDevices or Wiring: _ � ,�/�N,o�.ofa Dwices Equivalent OTHER C P� 4 ,, 5 UW°/ rii w/o '-G'r "'- ti Attach additional detail if desire4 or as required by the Inspector of Wires. Estimated Value of El 'cal Work: I ier (When required by municipal policy.) Work to Start: y/ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability'4 urance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cov,i-,le is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Y4 BOND ❑ OTHER ❑ (Specify:) I certify,under the,� / y pains and penalties of perjury,that the information on this lication is e and complete. FIRM NAME /� Gam' / C, LL C- / LIC.NO.: g6 di Licensee: j tl 1-• /�60l/Lii, Signature LIC.NO.:5ZO (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:7 f yy'_39-39 Address:30 R/ Desna br: ivg,7/t'''4/`,All 023 PO— Alt.Tel.No.:W 7 270-z-Y 2/ *Per M.G.L.c. 147,s.57-61,security work requires Delrn,bnent of Public Safety"S"License: Lic.No. 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 Signature Telephone No. I PERMIT FEE: $ g/t1,g/6 7 �j2c i4 C.Co J / ?J1e' by M