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Home My WebLink AboutBLDE-23-005606 _.' Commonwealth of Official Use Only ILA,4 Massachusetts Permit No. BLDE-23-005606 • 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:4/10/2023 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) 444 ROUTE 28 Owner or Tenant BROTHERS FOOD MART Telephone No. Owner's Address 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 ❑ 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 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 I 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 I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent 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: Licensee: John Robert Mara Signature LIC.NO.: 58035 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 15 Pinewood Road, West YArmouth MA 02673 *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. I PERMIT FEE:$330.00 I AL- q(2q(2T RECEIVED ty 'w` r APR 0 ram-IohVirea/th of Massachusetts Official Use O 1�i� __ Permit No.: (✓ ,10 , NG PA}Pg rt ent of Fire Services Occupancy and Fee Checked: t. I�= _BOARD^QE PREVENTION REGULATIONS [Rev. 1/2023] ' '`—"'4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code(MEC), M WORK City or Town of: YARMOUTH Date: //7 /z 3 To the Inspector of Wires:By this applicatio undersigned gives notices of his or her intention to perform the electrical work described below n,the . Location(Street&Number): y99 gT- Owner or Tenant: f Unit No.: L�/1 hTiyf/' A Email: Owner's Address: JQ.Lwi pc(fi f f Phone No.: Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.: Purpose of Building: Existing Service: `�O6 Utility Authorization No.: Amps 4 2 0/ 45Volts Overhead❑ Underground❑ No.of Meters: New Service: Amps / Volts Overhead❑ Underground Description of Proposed Electrical Installation: g ❑ No. of Meters: Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: No.of Switches: No.Luminaires: No.of Recessed Luminaires: Generator KW Rating: Type:. No.Wind Generators: Wind KW Rating: No.Appliances: KW: No. Water Heaters: KW: Space Heatin KW: No.Transformers: Total KVA: g Heating Equipment KW: No.Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices: Swimming Pool:In-Grnd.0 Above-Grnd. 0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: No.Air Conditioners: Video System 0 No.of Devices: Total Tons: Telecom System No.Energy Storage Systems: y 0 No.of Outlets: KWH Storage Rating: Security System No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Ratin �-AQ g• No No.of Modules: Roof-Mount 0 Ground-Mount .of Electric Vehicle Supply Equipment: OTHER: ❑ Level 1 0 Level 0 Level 3 0 Rating: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Date Work to Start: Inspections to be requested in accordance witluMEC Ruleired by l0 municipal FIRM NAME: and upon n completion. Master/Systems Licensee: A-I 0 or C-1 ❑LIC. No.: Journeyman Licensee: LIC.No.: �O3 � — 8 Security System Business requires a Division of Occupational Licensure"S"LIC. LIC.No.: Address: S-LIC.No.: Email: T I cert ,un er the sand penalties of the on this application el ne No.: 'f perjury, thatinformation is true and complete. ' Licens INSU E COV - Print Name:_�o�t^J Mph _ . n ess waived by the owner,no permit for the performance of electrical work may issueeunle s the7 licensee 75-7 6 provides proof of liability including"com ed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force and has exhibited proof of s e to the permit issuing office. ❑ CHECK ONE: INSURANCE BOND g Specify OWNER'S INSURANCE WAIVER: I am awarethat the Licensee does not•have the required by law.By my signature below,I hereby waive this requirement. I am the:(Check one Owner lity coveragen normally Owner/Agent: 0 Owner's agent❑ Tel.No.: Signature: Email.: