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HomeMy WebLinkAboutBLDE-22-006778 •�` Commonwealth of Official Use Only . Massachusetts Permit No. BLDE-22-006778 12tbBOARD 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:5/23/2022 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) 981 ROUTE 28 Owner or Tenant ATLANTIC DRAGON REAL ESTATE LLC Telephone No. Owner's Address 50-52 MCGRATH HWY, QUINCY, MA 02169 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 400 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: Demo and restore service to building. 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 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.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: DONALD E YOUNG Licensee: Donald E Young Signature LIC.NO.: 10312 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:250 S MAIN ST, RANDOLPH MA 023684828 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: $100.00 ( PC C` `L�a-11.3 K-- , 14 Commonwealth.4 Kmachadatto Official Use Only ='B"=� c� c� n Permit No. tP (' 7e © L t 'A'rl'%. 2spartmand of irs Jsrvicse "•'a,1.`. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (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 t (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: .c, ? -- ,Z , e� 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) /.� F..1 !`,()`(. ( .R' Owner or Tenant Lfj�i''/ LJ /�T ��,�J 0r� Ci/J - F. Telephone No. 4jl Owner's Address g3 f1+p/'/CQA44f'- ( /4/c cpt'/'`iMy /'1,i , :2ik'9 Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Box) Purpose of Building �' 13�' /- C/AL Utility Authorization No. Existing Service 6/t JQ Amps 4,20/a Yct Volts Overhead❑ Undgrd No.of Meters / New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity ---. � Location and Nature of Proposed Electrical Work: i/ 1J (I.N ;✓J4/r / (J f� Completion of the following table may be waived by the Inspector of Wires. - No.of Recessed Luminaires No.of Ceil:Sas No.of Total ,� p.(Paddle)Fans Transformers KVA '=-;t 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. f ofOil Burners FIRE ALARMS INo.of Zones ~ No.of Switches No.of Gas Burners 'No.of Detection and Initiating Devices ' No.of Ranges No.of Air Cond. Tons) No.of Alerting Devices No.of Waste Disposers Heat Pump Dumber Tons KW No.of Self-Contained Totals:I }_ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Minicipal Connection ❑ �� No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin No.of Devices or Equivalent OTHER: 0Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: .,,j Oo,de (When required by municipal policy.) Work to Start: '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 0 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAM ,v� lPr".l (, , LIC.NO.: n103/--- Licensee: ,?• it?, ,/r;may Signature // r, LIC.NO.: .2/r 2 (If applicable,enter"exetv pt" Me limns umbe line.) , Address: c7 ('�_ �r` us.Tel.No.: .vim `� ,/i,( . rl ��L ,!'<%°/ ,'�i ()�:5 a Alt.Tel.No.: �� 5v� *Per M.G.L.c. 147,s.57-61,securitywork re u res Department of Public Safety"S"License: Lic.No. �� 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)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ /co I