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Home My WebLink AboutBLDE-22-001503 Commonwealth of Official Use Only filPifikA Massachusetts Permit No. BLDE-22-001503 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:9/16/2021 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) 210 STATION AVE Owner or Tenant DENNIS YARMTH REGIONAL SCHOOL Telephone No. Owner's Address STATION AVENUE, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (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: Annual maintenance permit 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 Initiating 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs 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: RUSSELL E MEALEY Licensee: Russell E Mealey Signature LIC.NO.: 14020 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 SIGNE RD, DENNIS MA 026382411 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 VtiM¢FOIGN,,.fclL FA '. 0. , - 19b3 MAINTENANCE DEPARTMENT Dennis-Yarmouth Regional School District 296 Station Avenue South Yarmouth, MA 02664 Telephone: 508.398.7670 Fax: 508.398.7663 Sandra Cashen, Facilities Manager Steve Faucher,Assistant Facilities Manager Cell 508.726.8161 Cell 508.889.8721 Date: 9/14/2021 To: Town of Yarmouth Electrical Inspector of Wires From: Russell Mealey, Electrician License No. 14020-B Re: Request Annual Maintenance Permit An electronic copy of all electrical work orders will sent monthly of each school to the Electrical Inspector for review. Request annual maintenance permit for July 1, 2021 through June 30, 2022 from the Town of Yarmouth Electrical Inspector of Wires for the following facility. DY Regional High School 210 Station Avenue South Yarmouth, MA 02664 Paul Funk Phone: 508.398.7630 Fax: 508.398.7635 Map/Parcel P/O158/15 Thank you, cc: Paul Funk Carol Woodbury Sandra Cashen Russell Mealey Electrical Inspector DYHS.doc Commonwealth of Massachusetts Official Use Only Permit No. a � Department of Fire Services OF FIRE PREVENTION REGULATIONS Permit Fee Assigned BOARD art' [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a I t y/2 City or Town of: �,.� �, y -1-In To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution DQ.AV1 s ytxirvh 014 Re7 v U I .S-61n n 0 1 it is M1 Address 2qG h &V[ . SGuI- Ihtv"t7'w-I-14/ ?lick O2C 6�( Location and Nature of Proposed Electrical`Work: j) y W 15J1, Si,In / 210 S4u9-1t 1., At)c L 'b1 i O).C.6 a �wA io.- C Der �— NOTE. C. 143 §3L of the Massachusetts General Laws obliges those who perform electrical installations to give notice of same to the municipal Inspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contemporaneous log of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance notice. Some municipali- ties may set nominal fees for annual permits and require individual permits for work above a stated magnitude. We will file this form on each such occasion(check one): YES a NO ❑ We will maintain one or more contemporaneous log(s) (check one): YES g NO ❑ This option is available where so contemplated by the municipality. In these cases,you must renew this application annually, and upon significant changes in employment. The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverage,and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure,indicate below how the Inspector of Wires should access the log: Scl~0 I �v,�e How many electricians and/or system technicians(as licensed by the Board of State Examiners of Electricians)do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §8)? In general,this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962,c. 582§3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: () Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141§8. (Please see reverse side for certifications and required signature.) Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution, similar to institutional employees. If,by the terms of such a contract,you direct the performance of such work, include the num- bers of such employees in this application. If the contractor directs such performance, of if the contract period is for less than one year, application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title, such as "Director of the Physical Plant" or "Director of Facilities" or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c. 141 §8 for electrical work on the prem- ises of your institution, and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: f E I 1 }--ci au()r- - My authority to act for the aforementioned institution is: I certify,under the pains and penalties of perjury,that the information on this application is true and complete. , a G Al___.?Al___.? (Dated) . -s 2, nt name) _X:+L.rrk1s CC't_ _r) (work telephone number) 3 72&''/ (extension) (facsimile number) E 8 7(_, 3 1,23..5 �-� L'ci c'" 'i t tYL LYE 614,i_, i e,i_e_c__ Ili c_c__,_ r,j_.,,,„_,_, rkry) tf-A.e._, Ci 1 (-0 c---F- , f 'c am ec - cr_ �6 1 e_ k) I be— al -�-e. I 1 c c_e_ns_e_cl 0 ---(--- CIr-d-- �c=f c�r • 4(\"-I pro 'c,cf' co,),2..... b. v - - -�dv e.. l e, �c---c0-4-1S �=�