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Home My WebLink AboutBLDE-23-004184 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-004184 i91 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:1/27/2023 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) 125 ROUTE 6A Owner or Tenant UROLOGY ASSOCIATES of CAPE COD Telephone No. Owner's Address 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: Voice&data cable installation. 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 le) Total Transformjrs KVA No.of Luminaire Outlets No.of Hot Tubs Generators , 3 , 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. Ton l No.of Alerting Devices 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW rNo.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: 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 my signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $115.00 Ai : II en/41 I'/Y1(11(/1 RFCEIV_ED _ N 27 2023 ° atuealth el r//GddaGkudeite OtT ialinI Use—L,3- J Only1 1� I c7• Permit No. � i(et-- al giro a/rooked ,N G DEPARTMENT Occupancy and Fee Checked _ __BOARD-OF FIR 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 TYPE ALL INFORMATION) Date: 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) J a 5 Q I4 16 r15 /t 3 /71,q]1 Lt/t. Owner or Tenant (J r_0 lt'+t)v ill S�Rf:li.as7"sci CV cap is 6,,j Telephone No. Owner's Address / Is this permit In conjunction with a building permit? Yes ❑ No ❑—(Check Appropriate Box) Purpose of Building ]r]tr';t,( (7&1.c Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity ILocation and Nature of Proposed Electrical Work: U p;C k t n 44-rul- /.krt.vNrK V) Completion of tltefollowin&table mg be waived by the Inspector of Wires. lli No.of Recessed Luminaires No,of Cell:Sasp.(Paddle)Fams No.of 1 otal .-./ Transformers KVA nNo.of Luminaire Outlets No.of Hot Tubs Generators KVA 4 No.of Luminaires • Swimmingpool Above In- No.of Emergency Lighting _grad ❑ grad. ❑ Battery Units 'i 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 i;! No.of Ranges No.o Air Cond. ao i ' No.of Alerting Devices No.of Waste Disposers Totals: Pump Number Tons KW No.of Self-Contained Totals:I �''-"'' `_{_"' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Connectio nic(pal n 0 ��, Co No.of Dryers Heating Appliances KW Security Systems:" 'No.of Water No.of Devices or Equivalent Hasten KW No.of No.of Data Wiring: Signs 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 lee teal Wotk: 1 30,('0 (When required by municipal policy.) Work to Start: Inspec ions to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE 77 RA E: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insu including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0(Specify:) I certify,under the pains and penalties of perjury,that the Information on this application is true and complete.r^ FIRM NAM r7'1.✓c^iC Er/: L 'F/,',' Ai-j�- hq O s L� LIC.NO.: Licensee: N=� J Signature �� !"('-'� LIC.NO.: (Ifapplicabl !Fr' mpt"'nthelicensenumberli Bus.Tel.No.. .Sf,0.9dA-`/ASS Address: `J r•61 f 5 T, h`l/I d.�,,y- in L'¢ 0)7 1 Alt TeL No.: Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSU CE I hai awareebythat the Licenseer does riotla have the(chekliability e insu a coveragenormally e/ y law. y y s' re below,I hereby waive this requirement. I am the(check one) owner ❑owner's agent. Owner/Agent Signature v Telephone No.6i' -7 -vs-,A PERMIT FEE:$