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Home My WebLink AboutBLDE-22-003511 or ikiR2 Commonwealth of Official Use Only /-114\ Massachusetts Permit No. BLDE-22-003511 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:12/23/2021 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) 92 OLD TOWNHOUSE RD Owner or Tenant FMR REALTY LLC Telephone No. Owner's Address 92 OLD TOWNHOUSE RD, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Chew I .1 . Box) Purpose of Building Utility Authorization No Existing Service Amps Volts Overhead 0 Undgrd 0 O New Service Amps Volts Overhead 0 Undgrd 0 4te Number of Feeders and Ampacity D Location and Nature of Proposed Electrical Work: Install (2)30A outlets and (1)GFCI outlet < t t. Completion of the following table may be Ale' Abe ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers el O KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency it g z5 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 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: $120.00 —n,cfri /243/Lt , fJI,e Zile IV, ' `S`uu\ commonweafin u► ►aaDOataeuM.,..r•-F I permit No. ��' z 7/ 'N il �I in Department of Fire Services ccuy and Fee Checked e IL BOARD OF FIRE PREVENTION REGULATIONS IROev.9p/OSIan c (leave blank) APPLICATION FOR accordancermed in the PERMIThTORS PERFORM eELECTRIICAL Date: WORK All work to be h7 r ^^ x (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) To the inspector of Wires: City or Town of: yra v tY vt� '� By this application the undersigned gives notice of his or fier intention to perform theelectrical work described below. Location(Street it Number) Z i�i� Telephone No. �7�F ai 3k`iz• Owner or Tenant i Owner's Address (Check Appropriate Box) Is this permit in conju'9Iction with a bull ing permit? Yes E No El Authorization No. Purpose of Building (. `,A Util rd Existing Service, C Amps "il l f olts Overhead] g E] No.of Meters I lNo.of Meters New L_ Amps _ Overhead E Undgrd Volts Number of Feeders and Ampacity sr 0 cat / Location and Nature of Proposed Electrical Work: Coin tenon o the °Bowen table tnav be waived by the Ins ecator o Wires. No.of Ceil;Susp.(Paddle)Fans TransformersI:. Generators KVA No,of Hot Tubs No.of Luminaire o.o mergency ig tug No.of Luminaires Swimming Pool ,rd e ❑ rnd. ❑ Batter Units of Oil Burners FIRE ALARMS No.of Zones No.of Receptacle Outlets No. o,0 election and—� No.of Gas Burners Initiatingting Dew_ No.of Switches ota No.of Alerting Devices No.of Air Cond. Tons No.of Ranges eat ump m er OI1S Detection/Alertin Deviceso.o el• onta ne u... .,,..,,,,,._ . No.of Waste Disposers Totals: unicipa ❑Other Local 0 Connect Space/Area Heating KW ion No.of Dishwashers No Heating Appliances KW ee y yS ems: No.of Devices or E uivalent No.of Dryers o 0 0.o Data Wiring: o.o star KW Si ns Ballasts No.of Devices or E uivalent Heaters a N No.Hydromassage Bathtubs omm No.of Motors Total HP No.of Devevicesices lulu or E uiva ant OTHER: Attach additional detail if desired.or as rewired by the Inspector of Wires. Estimated V slue oft E^�e tr2 al Work: �— (When required by municipal policy.) Work to start: I I—I LY Inspections to be requested in accordance with MCC Rule to,and upon completion. for the erforinancc of INSURANCE O prof of liability insurance inc incl the uding completed no toperation"coverage or tsectrical work substantial equiyvalent The the eccl provides undersigned certifies that such coverage is in force,and has exhibited❑ (Specify of same to the permit issuing office. BOND ❑ is tale and complete. CHECK ONE: the am a enalties of perjury,that the information on this applicationLIC.NO.et I certify,under the sins and penalties 1 FIRM NAME: LIC.NO:"Z.Z�ir�'' W NE Signature Bus.Tel.No.: a Licensee:le �� 1)�, M � -► pit.Tel.No: �Ill.' A(If dresable,enter'exempt lit thehcensenrali1� ` Address: s�CoMrac— ere: *Security System Contractor License required for this worK;if ap�lwable,enter the license number owner ill alert, that have t(check one)i❑ranee coverage normally required by law. By my signature below,)hereby waive this requirement. I am the Owner/Agent Telephone No. _ __---- Signature �'"+� f