HomeMy WebLinkAboutBLDE-22-00237 Commonwealth of Official Use Only
,t ; Massachusetts Permit No. BLDE-22-000237
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:7/14/2021
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) 497 ROUTE 28
Owner or Tenant GRIFF HOLDING CORP Telephone No.
Owner's Address 497 MAIN ST, WEST YARMOUTH, MA 02673
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: Wiring for HVAC(BUILDING#2)
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
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 ❑ 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: JOHN M PIMENTAL
Licensee: John M Pimental Signature LIC.NO.: 27968
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 1158 E FALMOUTH HWY, EAST FALMOUTH MA 025365455 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
tture Telephone No. PERMIT FEE: $100.00
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11' ' • Occupancy and Fee Checked
> _ BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in acconlance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
01 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: -7- 1 3 - i.o a 1
City or Town of: Y1zYMii✓K To the Inspector of Wires:
1 By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) y g 7 RI- i 15 J- ytor,Wti ON
Owner or Tenant l.7(`i P f 17?/6Li At C a e P Telephone No.
4` Owner's Address Says.,
`s Is this permit in conjunction with a building permit? Yes No ,E'ii (Check Appropriate Box)
.ti 6z
Purpose of Building APe r+ .,4. 4�ui It. ni- v,le,in,, I6 Utility Authorization No.
No Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
/ Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: o 14- . L i fi.e e o r e J
AG (Ant"/ ,.(/I'n'r y ".. f3�)i At 0 L
rnf Completion of the followingtable m be waived by the i ector of Wires.
Lb No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
Q1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
't No.of Luminaires SwimmingPool 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
t•i 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
l Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ M Systems:/
❑ Other
C
No.of Dryers Heating Appliances KW Security No.of Devices or Equivalent
No.of Water , No.of No.ofK Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring:
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: .7-13—ja,l 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 cov ge 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,that the information on this application is true and complete.
FIRM NAME: _ L1C.NO.:
Licensee:�i')1wk Al 1'n l rN r1 Signature i v LIC.NO.: 1 910 I r-
(lf applicable enter"exempt"in the licensenumber line.) Bus.Tel.No.•5 5 1 7.t.
Address: ea 3 L/ f rie.5 •.v(e Mk O cZ Ley 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 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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
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