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HomeMy WebLinkAboutBLDE-22-003712 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-003712 w 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 12.09, (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:1/4/2022 City or Town of: YARMOUTH To the Inspector of Wires By this application the undersigned gives notice of hts or her mtentton to perform the electrical work described below. Location(Street&Number) 1146 ROUTE 28 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❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Mete New Service Amps Volts Overhead 0 Undgrd 0 No.of Meter � Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of 64 data cables. b. 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 Initiahne 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:" No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: 64 Heaters Sians 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: Alt.Tel.No.: "Ter 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 - ''' Co�runonweatth o/�aosac etj Official Use Only E/2-d? 27l '7...../ ..,, ��'-��►—�t c� Permit No. -� 3 t= 2 art►nent o Pire Serviced _� _i=t Occupancy and Fee Checked -t y .y BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) r-- ---1w PPLICATION FOR PERMIT TO PERFORM. ELECTRICAL WORK Ili ; N ' 2 I All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 cm 1 P, EASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ,i ��/22 w44, 1 City or Town of: Y J1„ 'e ,--7 To the Inspect& of Wires: W ` O T33T is application the undersigned'gives notice of his or her intention to perform the electrical work described below. I .Q Lo Lion (Street & Number) 1/ y4 tbet - _V > yi,g?ea,->{ /$24 i2zZ l ci)L!� 1 p er or Tenant Telephone No. 5. .;/C,2),3 OVA er's Address l/ ljt m4 ` .)S- .r YA/2/41t cii /s?)J O.:'C"V Is this permit in conjunction with a building permit? Yes ❑ No [3-- (Check Appropriate Box) Purpose of Building ).:4-,'v (,3Ffx- er Utility Authorization No. Existing Service A.li Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service ,.,i,x, Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity /t 'I Location and Nature of Proposed EIectrical Work: _ems;`7)14,1 rx' °` -..'"y ,.+ G./iI S %3,- ,'i/G .. ,— :/- ofiif zi j Completion of the following table may be waived by the Inspector of Wires. Total No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans Transformers o. of KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires SwimmingPool Above ❑ In- ❑ No. of-Emergency Lighting grnd. grnd. Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones 4- No. of Switches No. of Gas Burners I 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 a Municipal No. of Dishwashers Space/Area Heating KW Local ❑ ❑ Other Connection ' No. of DryersHeating Appliances KW Security Systems:* No. of Devices or Equivalent 4 No. of Water No. of No. of KWData Wiring: Heaters Signs Ballasts No. of Devices or Equivalent '1 v No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsDevcor l No. of Devices Equivalent r OTHER: J Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: . " j, 6-c (When required by municipal policy.) Work to Start: z . -"/>i Inspections to be requested in accordance with MEC Rule 10, and upon completion. ;S INSURANCE C4 ERAGE: 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 Q BOND ❑ OTHER ❑ (Specify:) v) I cert ft, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: f, C ilLe 4" ,:,''/4.s LIC. NO.: -( ,,, Signature - , LIC. NO.: / ,k(..s-pr � Licensee: ��� 747, G�.c��,9,-c g l�i4 (If applicable, enter "exempt" in the license number line.) Bus. TeL No.: `-/ ' ��s "-ib 1 L Address: '' �, x 7 .S '-�; G +Jell 11�s u�'`� �� Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. CI OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally Erequired by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. 1 Owner/Agent Signature Telephone No. PERMIT'FEE: $