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Home My WebLink AboutBLDE-22-001665 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-001665 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:9/22/2021 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) 507 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 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install conduit&cat V for card reader communications. 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. To No.of Alerting Devices 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 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: 1 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 A LOMBARDI Licensee: ROBERT A LOMBARDI Signature LIC.NO.: 35866 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 1794 ROUNDTOP ROAD, HARRISIVILLE RI 02830 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 akt\jak SAM; ('r Caves, CowlT 4/z-4/2 J eteti1 Sacsvt ck, Commonwealth o/Maeaaehuaai a Official Use Only(( / k • 7v , c x Permit No. ��-- ( 5' , ;„K.Bev— ' eparttmant 0/ ire ervicea 11. 'k.) � jam 4,-1 Occupancy and Fee Checked -- a'' BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1107] (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 r.,,, ,a (PLEASE PRINT IN INK OR TYPE ALL INFORAM TION) Date: /,/,2 /2 a.1.-) _ _ City or Town of: To the Inspector of Wires: 6)7 J ': By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) S--i-- C )4--SUC.(� Owner or Tenant J�,(y✓t c c> `7 l t 6 f (/ti Telephone No. l�C4ni - Z Owner's Address v Is this permit in conjunction with a building permit? Yes C No V (Check Appropriate Box) CJ Purpose of Building f b,..) Utility Authorization No. ` ~ Existing Service Amps / Volts Overhead Undgrd No. of Meters _ k---- New Service Amps / Volts Overhead❑ Undgrd C No.of Meters Number of Feeders and Ampacity // 2' Location and Nature of Proposedr� Electrical Work: IN 7 Tek// cc,v c(✓ ,-/ /Lieu" CAT S` 1"02 (",t-fj PCA./p/c (eltM c1,,,fcc2 , veq,/ Completion of the followin_table may be waived by the Inspector of Wires. No.of 'I otal No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grad. 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 Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices71 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices g No.of Dishwashers Space/Area Heating KW Local❑ Connection g---, Other No.of Dryers Heating Appliances KWecurity vstems: No.of bevices or Equivalent _ No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HF Telecommunications Wirin : No.of Devices or Equivalent OTHER: 4/ Attach additional derail if desired, or as required he the Inspector of)fires. Estimated Value of Flee ical Work: 7S 4 Oa (When required by municipal policy.) Work to Start:Air r , da Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVE - GE: 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,�t,-ha�^t�t e information on this application is true and complete. FIRM NAME: e ,,a . µ,t, l�(�9 LIC.NO.: 3',3'tf`4 k Licensee: 6 st .` „ _ . L Signature 4 LIC. NO.: `'c / (f pP ' .3 s e 4�.!� 1 a lrcahle,enter 'eren t'"in the!' en•e number rr Address: V- /� /� Bus.Tel.No.: ? l 7f "o,,c,al by j).,`d vG <! o 8-9$J Alt.Tel.No.: L1Pf. J 0V 3Tb ./ *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 am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)E]owner ❑owner's:.Vicat. Owner/Agent _ Signature Telephone No. j PERMIT FEE: