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Home My WebLink AboutBLDE-22-000429 CommonwealthMassachusetts of Official Use Only i'S)..___.:ii.-,-4,i4\ Permit No. BLDE-22-000429 ''- 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:7/22/2021 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) 520 BUCK ISLAND 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 ❑ (Check Approp t Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 140 New Service Amps Volts Overhead 0 Undgrd 0 `^. Number of Feeders and Ampacity Q ^ 0 Location and Nature of Proposed Electrical Work: Install receptacles on parking lot light poles.(F.D.Station#3) Completion of the following table mwf�waivv tt a .1 to f Wires. Luminaires No.of Ceil:Sus addle Fans No.of • No.of Recessed p(P ) �2� .� Transformers '� No.of Luminaire Outlets No.of Hot Tubs Generators 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KWNo.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 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: ROBERT J CARLSON Licensee: Robert J Carlson Signature LIC.NO.: 38869 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:39 NAUSET RD,W YARMOUTH MA 026733752 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: $0.00 Co7�mmonwmn[h o`t/Iaedarh atte /OO�fficial Use Only �C.Ia tenant��in Jmks', Permit No. liZ2.—O L.21 par a I,• Occupancy and Fee Checked iltli 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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7'—..� — -2/ 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) v5',„/0 Owner or Tenant T/_/i,f ,-,/,- � ud/7 '?7 0,e phone No. Owner's Address `•.-1 c) i'j p- ']yJ 2 Is this permit In conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /tea' O / z `i Completion of the following table may be waived by the In pector of Wires. y/1 - U. No.of Recessed Laminairea No.of Ce6:Sosp.(Paddle)Fans No.°f 7 otal Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA t- No.of Luminaires Swimming Pool Above ❑ In. No.of Emergency Lighting grad. grad. 0 Battery Units No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and tr Initiating Devices No.of Ranges No.of Mr Cond. Tons Total No.of Alerting Devices No.of Waste Disposers 'Heat Pump Number Tons W, ., No.of Self-Contained Totals:I .` I -{IC . Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Municipa 0 Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water N of No.of Devices or Equivalent o. Heaters KW No.°f Data Wiring: 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 as required by the Inspector of Wires. 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 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 sins and penalties ofperjury,that the Information on this application is true and complete. FIRM NAME: Fri' ,y C y - n LIC.NO.: Licensee:v\eycy,,�i ("AO if/+✓ Signature LIC.NO.:E lee 6(If applicable,eat r"esem t"in the license nut er li ) / Address: �Jp Bus.Tel,No.. D g✓•=sY,0457 15�-� Alt.Tel.No.: Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. 1 sin the(check one)❑owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:S