HomeMy WebLinkAboutBLDE-23-006152 Commonwealth of official use only
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..., x. Massachusetts Permit No. BLDE-23-006152
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 Codc (MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:5/7/2023
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) 717 WILLOW ST
Owner or Tenant PEARSON DAVID T Telephone No.
Owner's Address PEARSON THERESA M, 3440 AUSTIN CT,ALEXANDRIA, VA 22310
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 0 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: Install security&fire system.
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 1
No.of Switches No.of Gas Burners No.of Detection and 9
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices 12
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 9
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: 1
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
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: Robert K Boucher
Licensee: Robert K Boucher Signature LIC.NO.: 1317
(I/applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:218 SETUCKET RD, YARMOUTH PORT MA 026752258 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: $45.00
Commonwealth of Massachusetts Official Use Only
t Permit No. _ (G' -S Z
0.. Department of Fire Services
_=�` Occupancy and Fee Checked
, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] (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 AL L INFORMATION) Date: 0 S`- 6 3•-.Z
City or Town of: / v--en 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&�Nnumbber) '_/ 7 1-J iV/'u -'; ��� _, - ---
Owner or Tenant r 1 C at-42 t4S.s22%.
�C - (�yr'st-t-N Re,o'de„c-c., Telephone No.j crr' -5--�.17(.,
3 -
Owner's Address ;' > R k 4)cf- C� jr„�1S'/ .977/ U z6 t'/
. ._.._..-..—Is,this permit in conjunction with a building permit? No (Check Appropriate Box)
r____-_7 F-PI rpose of Building t�-� �%, . Utility Authorization No.
z
w
3l; ,r) isting Service Amps / Volts Overhead C Undgrd 1 N `� g No.of Meters
0
�+ 1 w Service Amps / Volts Overhead
�.�I in ii Undgrd n No.of MetersN tuber of Feeders and Ampacity
LI j - ation and Nature of Proposed Electrical Work: / '. vo7'f z 5� "y
6 1 /
0
2.____k_
4eLw cl 41, w �eyn S'Y,r`I'� m w Completion of the following table may be waived by the Inspector of ll'irer.
--. - --- .of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
i
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
N
No.of Switches No. of Gas Burners No.of Detection and
Initiating Devices
No. of Ranges No.of Air Cond. Tonsl I No.of Alerting Devices / 2-
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 El Other
Connection
No.of Dryers Heating Appliances KW Security Systems:`
No.of Water No.of Devices or Equivalent
No.of No.of
Heaters KW Signs Ballasts Data Wiring:
No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
/ c�r. Attach additional detail ifdesired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: '3 C' G (When required by municipal policy.)
Work to Start: 0.5 ;.•3 -›-3 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: Seaside Alarms itie. LIC.NO.: 1317C
Licensee: Robert K. Boucher Signature;&r, * ILL,`_ Pa.c,s‘,,.,--LIC.NO.:
(If applicable,enter "exempt"in the license number line)
Address: 1265 Route 28.South Yarmouth, MA 02664 Bus.Tel. No.: 418-394-0ti99
Alt.Tel.*Security System Contractor License required for this work; if applicable,enter the license number here:No.: = 0046
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: $ - r