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HomeMy WebLinkAboutBLDE-25-497 Commonwealth of Massachusetts Official Use Only r-y it p et Permit No. zs�' 4 9 f „ Department of Fire Services �.-t r �`� o OccupanBOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] and Fee Checked .s; (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: O 4-74-/S`- -£ City or Town of: Yw rh a t4;4-L, 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) a U 6 ‘S a c-L"f`1_, SQe_1 Owner or Tenant R;c,k Ay, moo;,sf.-1_ � ,t_�, i es_ G�p,Ge_ Telephone No.S��-�4.-a Owner's Address /2-�/ Q�e_t -, ,4 ,e,,,� 1 / i.,,A?-CL, m41- c --(44S' Is this permit in conjunction with a buik44ing permit? No (Check Appropriate Box) Purpose of Building PQl Qh. , La_[! Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 0 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: c L� tip l45 L e S Q' 4..a w 4 .'ire oCc yv,.. #0, Completion of the following,table may a waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total .._,....,�.a.� Transformers KVA No.of Lumina r{Out)els. No.of Hot Tubs Generators KVA No.of Luminaaire Swimming Pool Above In- No.of Emergency Lighting t >� 15 2025 g grnd. ❑ grnd. ❑ Battery Units / No.of Recept 5cie Out a No.of Oil Burners FIRE ALARMS No.of Zones ' No.of Switch BUILDING DEPARTP�'E 1 •of Gas Burners No.of Detection and /O By Initiating Devices -_ -- --- Total / i. No.of Ranges — -No.of Air Cond. Tons No.of Alerting Devices 3 No.of Waste Disposers Heat Pump Number Tons }KW No.of Self-Contained Totals: Detection/Alerting Devices C No.of Dishwashers Space/Area Heating KW `Local❑ Municipal Connection ion © , No.of Dryers Heating Appliances KW sec :* No of Devices or Equivalent d 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: r[ 1 1 �/ No.of Devices or Equivalent h. h d OTHER: �61 ta e.E_ 4--s- (&��� 06 ci ,5'e nJ`UV--(I) c At'tach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 6 0 0 0 (When required by municipal policy.) Work to Start: 0 /'- -s 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 BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: - easide Alarms inc. LIC.NO.: 1317C Licensee: Robert K. Boucher Signature . I ..tL..., (1a c. ,o4„7--LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel. No.: >t1R-394-9499 Address: 265 Route 28,South Yarmouth,MA 02664 Alt.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: -0046 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 0 owner's agent. Owner/Agent PERMIT FEE: $ '&f° - Signature Telephone No. a-?c@�-41St)l ect.J.►-r».T,-'.0. /41 1 a .l .1 I r. ��