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HomeMy WebLinkAboutBLDE-21-07122 or Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-007122 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:6/8/2021 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) 20 DAVIS RD Owner or Tenant HOWARD LODGE AF&AM TRS Telephone No. Owner's Address MASONS CIO WM GREENE, P 0 BOX 303, SOUTH YARMOUTH, MA 02664 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: Replace lights&add receptacles in dining hall area. 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 20 Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 3 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 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 Number , Tons KW No.of Self-Contained 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 Data Wiring: Heaters Signs Ballasts 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 us 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 ❑ 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: John H Brewer Licensee: John H Brewer Signature LIC.NO.: 14092 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:205 CEDAR ST,W BARNSTABLE MA 026681324 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $80.00 13 CL t/oLer i � ►. AO) ,) (sueCJ I Official Use Only Commonwealth ofiviassachusetts Permit No. � —7 j Z?/ R Department of Fire Services t. Occupancy and Fee Checked LKev.i/U7j -. BOARD OF FIRE PREVENTION REGULATIONS (leave blank) APPLICATION FOR PERMIT TO PI RFORIvrI ELECTRICAL WORK All work to be perforated in accordance with the Massachusetts Electrical Cop` 52 MR 12.00 (PLEASE PRINT IN INK.OR TYPE ALL 17VFORtYIATlO ) Date: ( , ,7/ City or Town of: 4/004,`- To the In ect of Wires: By this application the undersigned ves notice of his or her intention to perform the electrical work described below. Location(Street&Number): Owner or Tenant (�t � Telephone No. Owner's Address is this permit in conjunction with a building permit? Yes No El (Check Appropriate Box) Purpose of Building L<1-42 C9 L Utility Authorization No. Existing Service Amos / Volts Overhead rr❑77 Undgrcl 0 No.of Meters New Service Amps / Volts Overheadl_( Undgrd0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed�Elecct/J'V L L ` Completion of the following table maybe warped by the Inspector of W res No.of pint Na.of Recessed Luminaires ,No.of CeiL-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets (No.ofHotTnhs Generators ISVA u oove In- No.or Emergency?, hung No.of Luminaires }Swimming Pool grad. Li grnd. Battery Units No.of Receptacle Outlets }No.of Oil Burners >s3iE ALARMS INo.of ZonesNo.of Detection and INo.of Switches INo.of Gas Burners Initiating Devices Total No.of Ranges 1No.of Air Cond. Tons No.of Alerting Devices Heat Hump m erTons yI1CW Han sir ^ominW No.of Waste Disposers Totals:�-- l I --Detectlon/AlertiagDevices Mu nicipal Space/Area Heating KW (Local"Connection Other No.of Dishwashers p No.of?fryers �;3eatiug Appliances CW Security Systems= No.of Devices or Equivalent WaterION No.of No.of Data Wiring: No.of Ballasts No.of Devices or Equivalent Signs Heaters 'i'elecomrnuaieadons Wiring: No.Plydromassage Bathtubs INo.of Motors TotaUHP No.of Devices or Equivalent OTHER: Attach additional detail ifdesired or as required by the inspector of lYir es. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start 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 cove is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE:INSURANCE 5 BOND❑ OTHER❑(Specify:) i watt',under the paints and penalties of"pterja y,1,/un the infonnatiprt( ll t i.ss application s true and complete. FIRM NAME:John Brewer Electric 11 F•;%Ja/✓Z1/ , t .j 4/4a• 07-71 LIC.N©.:E21949 Licensee: .. c- Signature 4'.tA.-'- '•- Bus.LITel.0 NO.:A.14092 . e t /ffappiicabla enter'exempt"in the license number hire) -- Address: 73 bIi.i- CE- f e3i-7J Jl?t'>rr1S'' -?,1L4.-5 ✓,q t If Alt.Tel.No.:508-367-0167 'Per M.G.L. c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S EN _ICE WAIVER:I am aware that the Licensee does not hove the liability insurance coverage normally required by .By s' below,l hereby waive this requirement I am the(check one) Eller I]owner's anent. Owner/A t Signature 1/1.---- TelephoneNo�(s)/ )CI7 PERtifIT E: .'_i