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Home My WebLink AboutBLDE-23-004862 C Commonwealth of Official Use Only Ems, Massachusetts Permit No. BLDE-23-004862 11:1, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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:3/4/2023 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) 50 WORKSHOP RD Owner or Tenant TOWN OF YARMOUTH Telephone No. Owner's Address 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 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: Permit for work done without a permit.To include opening ground for inspection of U/G conduits.(NEW SCALE) 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 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 ❑ 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 Eauivalent 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 ❑ (Specify:) . l—2_ --24 9 , I certify,under the pains and penalties of perjury,that the information on this application is true and complet 6 ( FIRM NAME: WILLIAM J CLINTON Licensee: William J Clinton Signature LIC.NO.: 13567 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:70 MANN ST, BELLINGHAM MA 020192231 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: $200.00 -t2 &Jt REI_EIVIED /J AA,I yyt / �— .. ___. CJommonwea[th 0/lr/assaMaaettt Official Use Only j ' i`3 2023 "t{ �r n Permit No.�23 -L-I�Ov �epar�nt of gi,w.S.ked 1 I . Occupancy and Fee Checked eui •.� E PABOlelFBIBr FIRE PREVENTION REGULATIONS [Rev.1/071 (lease 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 (PLEASE PRINTIN INK OR TYPE ALL INFORMATION) Date: 3- s -t-9-O? City or Town of: ytr!) jt To the Inspector of Wires: By this application the undersigned gives notice of his or her m4ion to perform the electrical work described below. Location(Street&Number) i rpS�lnn Yqd Owner or Tenant T( n OF K''yytDikk Telephone No. ,3q des l Owner's Address Is this permit in con/uocppa with a bulldigg permit? Yes 'No (Check Appropriate Box) Purpose of Building C yr)nt area( Utility Authortratton No. ,C2/A Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meter Number of Feeder and Ampadty Lon and Nature of Proposed Electrical Work ¢ �t _ao BUG urdtr ofi)vet`u yt Pcwer Ca. L.k tie 6 tittero., Completion of thefollowMKtable may be waived by the Gar of Wires. No.th Total No.of Recessed Luminaires No.of Cell-Rasp.(Paddle)Fans Transformer KVA et t No.of Luminaire Outlets No.of Hot Tubs Generators KVA t No.of Luminaires Swimming Pool A e o.o .mergency .ig ring Rind. grnd. Battery Units J No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Detection and i No.of Gas Burner initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposer Heat Pump Number you k No.of Self Contained Totals:I I — I--W____.. Detectlon/Alertin Devices No.of Dishwashers Space/Area Heating KW Local 0 l'iConneeetion CI Other No.of Dryer Heating Appliances KW tecurlty Systems:" o. No.of Water No.of No.of Dam Wirt iDevices or Equivalent Heater KWSigns Ballasts No.of Devices or Equivalent No.Hydromaasage Bathtubs No.of Motors Total HP Telecommunications I%Oring: No.of Devices or Equivalent OTHER: 46 q r- der, Attach additional detail if desired or at required by the Inspector of Wires. Estimated Value of Electrical Work: i /,/ %-� (When required by municipal policy.) Work to Start 3.3'‘919a3 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: INSURANa�ND 0 OTHER 0(Specify:) I certi y,under r o a FIRM NAME:� e/a� '!`�O'that the information on this application is true and rnarPlee. / x>r ileMAte eetM w LIC.NO.:(3,167 g Licensee: �d'tnrrl ("(w,v Signature LIC.NO.: gi$A (Ifapplicnble,enter•'exempt_�•,In t t line) But.Tel.No..?'Y doll 2[46 Address: .�cMl)4- •C y t �.4 040 0 Alt.TeL No.: 'Per M.G.L.c.147,s.57-61,security ode requires Department of Public Safety OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havet he liability. insurance required by law. By my signature below,I herebywaive this coverage normallysagent Owner/Agent requirement. I am the(check one)[]owner owner's Signature _ Telephone No. I PERMIT FEE:$p .•I . _ .. _ .. r �. • ES(iS t:;;:`qA, . - I .e. f ,..- ... _ x... .h� .