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Home My WebLink AboutBLDE-23-001343 r Commonwealth of official Use Only L Massachusetts Permit No. BLDE-23-001343 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:9/13/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or Ilw intention to perform the electrical work described below.rcat ,r_1 Location(Street&Number) PINE ST Ti.,- ( l( Owner or Tenant BOY SCOUT CAMP Telephone No. Owner's Address 227 Pine Street,YArmouth Port, MA 02675 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 ❑ Undgrd 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install temporary service.(BOY SCOUT CAMP) 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 Initiatine Devices No.of Ranges No.of Air Cond. TTotal No.of Alerting Devices n No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Siens 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: TYLER W PAYNE Licensee: Tyler W Payne Signature LIC.NO.: 22091 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:5 JANS PATH, HARWICH MA 026452458 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: $80.00 14(A- 41/4111)/ QMcrx 64ArNitece— Official only - • Commonwealth of Massachusetts �2l Use y Permit No. i `,, r Department of Fire Services _, ,,,,I,-,-_- Occupancy and Fee Checked - ULATIONS (Rev.9/051 (leave blank) BOARD OF FIRE PREVENTION REG �- PERFORM ELECTRICAL WORK APPLICATION FOR PERMIT TO 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: I l� City or Town of: .. 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) 3,371 0 I rep r Telephone No. Owner or Tenant Owner's Address El (Check Appropriate Box) Is this permit in conjunction with a building permit? Yes UtilityNooAuthorization No. ..z...— Purpose of Building No.of Meters Existing Service I C Amps I ,/ _ olts Overhead ElUndgrd Und rd No.of Meters New Service Amps / Volts Overhead g Number of Feeders and Ampacity !,f �� Location and Nature of Pro'osed Electrical Work: -� c�( 1 --rer Con, letion o the ollox in- table may be waived by the Inso�cator o Wiles. o.o KVA No.of Ceil:Susp.(Paddle)Fans Transformers No.of Recessed Luminaires KVA No.of Hot Tubs Generators No.of Luminaire Outlets 'o.o mergency ig mg Swimming Pool ,rnd e ❑ I rnd. Batter Units _____No.of Luminaires ❑ No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Receptacle Outlets o,o etect� n an No.of Gas Burners ota Initiatin: Devices No.of Air Cond. Tons eat Pump Num er ons No.of Alerting Devices No.of Ranges _`1 O.o Self- ontatne' 'Detection/Alertin: Devices No.of Waste Disposers Totals: Municipal ❑ Other Local❑ Space/Area Heating KW Connection No.of Dishwashers -ecurrty stems: Heating Appliances KW No.of Devices or E s uivalent No.of Dryers o.o Data Wiring: erKW 'o'o Ballasts No.of Devices or E uivalent o.o $eaters Sins Te ecommuntcattons `tying No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value •f Electrical Work: (When required by municipal policy.) h Rule Work to Start: Inspections to be requested in accordfnce iter o mince of 10, antic upon completion.may issue unless INSURANCE VERAGE: Unless waived by the owner,no permit e�provides proof of liability insurance includins,'•complted operation- tiof same coverage t rhge orit its t issuing office.equivalent. The the ersilicv g P undersigned ce,tifies that such coverage is in force,and has exhibitedP CHECK ONE: INSURANCE . BOND 0 OTHER 0 (Specify:) is true and complete. that the information on this applicationLIC.NO.. f under the pains and penalties of perjury, Icertty, �c� � 1 • FIRM NAME: � G �� `� LIC.NO.:�.Z (,� *1. NE Signature / Bus.Tel.No.: • �3 Licensee: T l yy' 1p Alt.Tel.No.: w Z. (If applicable,enter "exempt" in the license number lure `_I MIA Address: tr l0 ,V e Licensee does not have the liability insurancecoverage vnerrs agent. *Security SyINSURANCEtem Contractor License required for this work;if applicable,enter the license number here: owner OWNER'S law. By WAIVER: I am aware that tPERMIT FEE: $ y By signature below,I hereby waive this requirement. I am the(check one) CI required by Telephone No. Owner/Agent Signature