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Home My WebLink AboutBLDE-23-005607 Commonwealth of Official Use Only 0. - l'illti zi Massachusetts Permit No. BLDE-23-005607 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 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: Installation of camera system Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans 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 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 Municipal No.of Dishwashers Space/Area Heating KW Local ❑ Connection 0 Other: HeatingAppliances KW Security Systems:* 16 No.of Dryers PP No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens 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. 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 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: $330.00 RECEIVED ' ( .:1 APR 07 23 � � omnlo wealth of Massachusetts Official Use my Permit No.:i', — (0 1 17 NG DEPARTrD p rtment of Fire Services Occupancy an Fee Checked: sE ._ —M E PREVENTION REGULATIONS [Rev. 1/2023] y''. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 MR 12.00 City or Town of: YARMOUTH . Date: 7'/7/.2_ 3 To the Inspector of Wires:By this ap pat*,n,the undersigned gives notices of his or her intention to perform the electrical work described below. Location(Street&Number): this ) Y T 8 Unit No.: Owner or Tenant:fl2 — zr/12J g h,po- Email: Owner's Address: Roy; pu-1-P( Phone No.: Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.: Purpose of Building: Utility Authorization No.: Existing Service: ye d Amps/10 / 206 Volts Overhead ErUnderground❑ No. of Meters: New Service: Amps / Volts Overhead D Underground❑ No. of Meters: Description of Proposed Electrical Installation: /1 Se-c to /z 1 %7 Cg/i'l tieA-5 Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:. No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: — No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No:Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices: Swimming Pool:In-Grnd.0 Above-Grnd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices: No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System IT No.of Devices: 1 6 Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ Rating: OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy) Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: A-1 ❑or C-1 ❑LIC.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: S8 6 3 S - ,b LIC.No.: Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: Address: Email: Telephone No.: I certify,unde the pains and penalties of perjury,that the information on this application is true and complete. Licensee: Print Name: J o et R) P µ A-it-p Cell.No.: ' 7!7c2 3 - g INSURAN COVERAGE• ess waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability including"co leted 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 0 OTHER El Specify: 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: Tel.No.: Signature: Email.: