Loading...
HomeMy WebLinkAboutBLDE-22-003442 a Commonwealth of Official Use Only i;,�'' ! Massachusetts Permit No. BLDE-22-003442 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:12/17/2021 City or Town of: YARMOUTH To the Inspector of Wires: `- . r-d By this application the undersigned gives notice of his or her intention to perform the electrical work described below. P Location(Street&Number) 50 LONG POND DR j ' Owner or Tenant DUMONT DONALD A TR / �'� , "9 ` Telephone No. \ y., \ ,, Owner's Address DUMONT COMMERCIAL REALTY TRUST, 642 MINGO LOOP RD, RANGELEY, ME 04970 , "‘ .. \ -N Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Bb4x) "'� Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters 'Ns ' ti New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters ,_ ) Number of Feeders and Ampacity N. Location and Nature of Proposed Electrical Work: Relocate receptacles on wall being taken down. 0 C� Completion of the following table may be waived by the n7 Spector 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 ❑ I ❑ 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 Initiative Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No No.of Devices or Equivalent HeatersWater KW No.of No.of Ballasts Data Wiring: Siens 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 operjury,that the information on this application is true and complete. f FIRM NAME: Edward J Noonan Licensee: Edward J Noonan Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 16411 Address:9 ROCKHILL ST, FOXBORO MA 020352305 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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:$100.00 w ; I 1 -eXn yu ) ) i ' )vV S RECEIVE ® DEC 16 2021e. �` �/J eai:th el„eteeachusatie Official Use Only ;pa DING DEPARTM T,,, niolgir.�i Permit No. Z—� ���� 11 ` rviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) City or Town of: S YARMOUTHDate: To ector By this application the undersigned gives notice of his or her intention to perform the electrical work described Location(Street&Number) 50 j 0 below. Owner or Tenant .zt� © Ornd (� Owner's Address 2.. U Telephone No. tj Is this permit in conjunction with a building per t? ye8* SQp---�`.. ec t `-� 0 No El (Check Appropriate Box) Purpose of Building i . L� Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters N rviee Amps / Volts Overhead Number of Feeders and Ampadty 0 Undgrd 0 No.of Meters _ M Location and Nature of Proposed Electrical Work: tiP No.of Recessed Coln,letion o the ollowin_ table m ev sed Luminaires No.of Ceil.-Sus , o.o be waived b the In ctor o Wires. "�,, No.of Luminaire Outlets p (Paddle)Fans No.of Hot Tubs Transformers KVA ` No.of Luminaires Generators KVA Swimming Pool ,rode ❑ a- ❑ 'o.oe mergency g ng No.of Receptacle Outlets No.of 011 Burners nd. Batte Units g No.of Switches FIRE ALARMS No.of Zones No.of Gas Burners `o.o t etec on an, t Inidatin, Devices No.of Air Cond. ota No.of Waste Disposers Tona No.of Alerting Devices eat 'nmp ...�um_er ons....._. `o.o e No.of Dishwashers Totals: out a , Det (-7 'un Devices Space/Area Heating ICW 'un No.of Dryers Heating Appliances Local Connection 0 Ot ler `o.o "a er KW ca tY ystems: Heaters KW `o.o o.o No.of Devices or uivalent Si ns Ballasts Data Wiring: No.of Devices or E,uivalent No.Hydromassage Bathtubs No.of Motors Total HP e ecommun ca,ons " ,g• OTHER: No.of Devices or E,uivalent Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) INSURANCE COVERAGE: Unl Inspections waived by the wner,nopermitested in accordance with p orma Rule and upon completion.kassu the;licensee provides proof of liability insurance including"completed operation"coverage or its substantial e undersigned certifies that such coverage is in force,and has exhibited proof of same to thepermit electrical work may issue unless CHECK ONE: INSURANCE G equivalent. The I card,jK under the pains and CEy BsOo De0 OTHER the ln�jo(Specif on thise . issuing office. fP r ry, (Specify:) FIRM NAME: 0 _ �"`� �-{ �4S3i�w' application istrue and complete. n r Licensee: LIC.NO.: T ' �-(b 1 c (/jappltcable,eater Signature \/� — — '"�-----'—.t` Address: enrpt to the llcens `um r line.) LIC.NO.:--� C�*Per M.G.L.c. 147,s.57-61,security work requires De Bus.Tel No.• OWNSOWNER'S INSURANCE WA Department of Public SafetyAlt.Tel.No.: required by S . i AR: I am aware that the Licensee does not havehe liability insurance overage n�" Owner/Age �. gnature below,I hereby waive this requirement, I am the(check one Signatur / owner owner's a;ent. Telephone No. PERMIT FEE:Jr C C � \