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Home My WebLink AboutBLDE-21-004694 Commonwealth of Official Use Only i*or . Massachusetts Permit No. :Bj 41 694 5 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:2/18/2021 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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install low votive OOrtril ' , *.r 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Hof 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 Data Wiring: Heaters Siens 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: 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.: *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 ...1ture Telephone No. PERMIT FEE: $0.00 . l 'sd Co�mmonweatt(al M- aeaaclusseits Official Use Only �i m' "„'J .LIe/oarLtineni of }ine ServicedPermit No�24 ' � 1;— * Occupancy and Fee Checked +, ,,.:;- BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/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 TYPtALL INFORMATION) Date: IC l a-/ City or Town of: rrY)0( To the Inspector of Wires: 924 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Nu r) 6 G'7 :a 1S/Qnd , d Owner or Tenant t""Y/n Y .t �t) Telephone No. Owner's Address tit ;C1--7 V 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❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ak A) De/L./calif(Lq Cat)Veil layc Oxiiit Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.o KVA fTotal „r Transformers VA K -: No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimmia pool Above ❑ In- ❑ No.of Emergency Lighting ��./ g fund. 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 Initiat[ng Devices `-' No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons KW_--- Det aection/Al mini Self-Contained D�m No.of Dishwashers Space/Area Heating KW Local❑ MuE� 0 Other Cannectioa No.of Dryers Heating Appliances KW Security Systems:* No.of Devices 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 HP Telecommunications Wiring LOLL) i b J� j� /� I-No.of Devices or Equivalent OTHER: LOt') V� f t'.�i ,'?Lf2 ' C AA/n.4. . Attach additional detail if desired or dd required by the Inspector of Wires. Estimated Value of Electrical Work: qst t06 (When required by municipal policy.) Work to Start 42//?J k 3-I 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 covge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ND 0 OTHER 0 (Specify:) I terrify,under the its and penalties o .erf ury, .at the hefonrrado, on this, fir ,,,rt is true " , c mptete. FIRM NAME: / / y/L (#• : mil :7e l? - LI NO.: Licensee: E)('I—VA/PT $ afar �� + ,�1dmi IC.NO.: j1G4�T Address:,enter ns j ere the license ber in {'�- - -Bus,TeL No.:/G/W A/QOOD . / .<< 1 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License: Lie.No. OWNER'S INSURAN WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by . By my gnature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. [PERMIT FEE: