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Home My WebLink AboutBLDE-21-005988 Official Use Only 0 Commonwealth of Permit No. BLDE-21-005988 ��, Massachusetts 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:4/15/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm 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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install security&camera system. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained s...../of Waste Disposers Totals: Detection/Alerting Devices ❑ Municipal 0 Other: No.of Dishwashers Space/Area Heating KW Local Connection Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. required bymunicipal policy.) Estimated Value of Electrical Work: (Whenq p p y' 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: RICHARD L SAMPSON nature LIC.NO.: 1212 Licensee: Richard L Sampson Signature (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 SHEFFIELD RD,WINCHESTER MA 018903529 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent I `mature Telephone No. 'PERMIT FEE: $0.00 Canaaanoreata DI Maseaclusselis Official Use Only Z -- Permit No. �2A se?d . • ' .�' bepadoent of Two&cries Occupancy and Fa Checked m ,.' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07) gavebladc .n 0 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 i (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: April 2021 IA City or Town of: Yarmouth To the Inspector of Wires: g By this application late undersigned gives notice of his or her intention to perform the electrical work described below. i Location(Street&Number) 74 Town Brook Rd OwnerorTenant Yarmouth DPW Telephone No. 0 Owner's Address 99 Buck Island Rd - Is this permit is conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) .o Purpose of Building Commercial-Gov't UtWty Authorization No. (' 3 Existing service Amps / Volts Overhead 0 Undgrd El No.of Meters if, New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters ---.-- f- Number of Feeders and Ampacity 1 Pt Location and Nature of Proposed Electrical Work: Installation of a security and camera system 6' tg w Compk/ton oftefol otring table mate be waived by the Inv actor of Wires. 1- No.of Recessed Luminaires No.of CeiL-Snap.(Paddle)Fans TN Generators f No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ in- ❑ 'rto.al Emergency ugating areal. toad. Battery Units = B• No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones `.e' No.ofSwitchesNo.of Burners No.of Detection and 3 - GasB _ ititlatityt Devices j• No.of Ranges No.of Air Cond. Tans No.of Alerting Devices Hest Pump Number.Tone KW No.of belt-Contained No.of Waste Disposers Totals: -"1 .. Detection/AuerpADevices • No.of Dishwashers Space/Area Heating KW Local 0 Cosaee ion 0 Orr No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Wiring: Heaters S� Ballasts Data No. Devices or kptvgleut_ No.Hydromassage Bathtubs - No.of Motors Total HP Telecommunications vWVfierilaaS No.of Devises or Equivalent OTHER: Estimated Value of Electrical Work: 50000 Attach additional detail it-desired or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start: ASAP 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of pedaty,that the Information on this application Is true and conmptete. FIRM NAME:American Alarm&Communications.Inc. ) ' LIC NO.: 12 1 2 C MA II Licensee: Richard L. Sampson, S r. Signature //i;- LIC.NO.:5 0 2 D inapplicable enter'mope-in the license number lire) Bus.Tel.No.:7111-641-2000 Address: 297 Broadway. Arlinaton. MA 02474 Alt.Tel.No.: *Per M.G.L.c.147,s.57.61,security work requires Department of Public Safety"S"License: Lic.No.S$CO 000090 MA OWNER'S INSURANCE WAIVER: 1 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)0 owner ❑owner's agent. SSignsturregest Telephone No. (PERMIT FEE:$ 115.00