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Home My WebLink AboutBLDE-24-455 3/21/24,6:52AM about:blank Commonwealth of Massachusetts . og Y-4 * Town of Yarmouth 0: dill h y ELECTRICAL PERMIT Job Address: 400 HIGGINS CROWELL RD Unit: Owner Name: TOWN OF YARMOUTH Owner's Address: 1146 ROUTE 28 Phone: Email: Purpose of Building Commercial Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-455 Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters: New Service Amps/Volts Overhead❑ and❑ No. Meters: ` I Description of Proposed Electrical Installation: Annual Maintenan ( E. Small-440 Higgins Crowell Ro r No.of Receptacle Outlets: No.of Switches: I Generator KW Rating: IV: p n No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: .Ni 1<WR g: No.Appliances: KW: No.Water Heaters: KW: No.Transformers: • -16ta Vy IJ Space Heating KW: Heating Equipment KW: No.Motors: Total HP: < fi _KW:f . - No. Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of D 4118 -,..„,), F Swimming Pool: ln-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Device]y No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices: , ' ,t`•-.r,• 1 4' '1 No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets: ' No. Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 0 Level 2❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 0 Work to Start: August 22, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: RUSSELL E MEALEY License Number: 14020 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: DENNIS, MA, 026382411 DENNIS MA 026382411 Fee Paid: $0.00 Email: fauchers@dy-regional.k12.ma.us Business Telephone: 508-398-7677 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. INSURANCE: 1/1 about:blank Commonwealth of Massachusetts -Offiic�ia�l Use1 Only / 1f_ tr-1 , Permit No. e2AA S si Department of Fire Services Vellf _tii Permit Fee Assigned -' '' BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK FOR INSTITUTIONAL* USE ONLY This form is for use by institutions employing licensed electricians and others for which notice of electrical installations to the municipal Inspector of Wires is required for work on the premises of the institution. If you are not an employing institution pursuant to C. 141 §8 of the Massachusetts General Laws,stop here. You cannot use this form. Use the standard form only. (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /2 Z•flL 3 City or Town of: Yporwi0N}-I,. To the Inspector of Wires: By this application the undersigned gives notice of the on-premises performance of electrical work by employees. Institution De,v.n,i —'4,rvi3Oi4.Pt, )49.C.netI cc.h,,t 0t14-riL+ Address-4 6 S'1`u4- A V e.. , .5 a,s1-� Yew vvi t�i3h, M cs,�)_b E H on and Nature of Propo d Electrical Work: N�uv 5 i.t ia-f! SrMixli ��Nn, S'e�.avl �1 0 d.l, :r. (,Y� I i�� lN�s} Yt+►rvr,,;.�}��rv1ry�, t�2613 Oin[9' p 1.t) W0v.K Q:aars NOTE: t. 143 §3L of the assachusetts General Laws obliges those who perform electrical installations to give notice of same to the muni ' nspector of Wires. You may do so by filing this form upon each such occasion, or if so contem- plated in an annual permit fee schedule set by the municipality you may maintain a contempor.•eous lo: of such work, which shall be exhibited to the Inspector of Wires during normal business hours without advance i off. sips neeni fioli .. ties may set nominal fees for annual permits and require individual permits for work above a states m. bus __, y__'^ We will file this form on each such occasion(check one): YES wi NO ❑ MAR 14 2024 We will maintain one or more contemporaneous log(s) (check one): YES E2 NO ❑ This option is available where so contemplated by the municipality. In these cases,you must rene e..1:s llr��ti8ah annAuRally and upon significant changes in employment. By ENT The following individual(s)will be responsible for the accuracy of the log(s),if maintained. You agree that the log(s)will be located as indicated below. The coverage in any individual log must be for contiguous property except by arrangement with the Inspector of Wires. Attach supplementary sheets if required for additional log locations. Log coverge,and location where it will be maintained Responsible person You may maintain the logs electronically upon agreement with the Inspector of Wires. If you intend to apply for such a proce- dure,indicate below how the Inspector of Wires should access the log: How many electricians and/or system technicians (as licensed by the Board of State Examiners of Electricians) do you employ at your facility? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: / Full-time equivalent electrical employment: How many helpers or apprentices do you employ to assist your licensed staff,under their direct supervision(see c. 141 §8)? In general,this number must not exceed the ratio of one licensed individual to one unlicensed individual. Limited exceptions ap- ply for veterans(see St. 1962,c. 582 §3 as amended by St. 1979,c. 156). Indicate the total number and also indicate the num- ber of full-time equivalent staff that number includes: Total electrical employment: a Full-time equivalent electrical employment: Not all electrical work for which notice to the Inspector of Wires is required must be performed by licensed personnel. How many such persons,not required to be licensed,do you have in your employ? Indicate the total number and also indicate the number of full-time equivalent staff that number includes: Total electrical employment: a Full-time equivalent electrical employment: *Institutions are defined for these purposes as any person,firm, or corporation operating under c. 141§8. (Please see reverse side for certifications and required signature.) Institutional Permit Form,page 2 NOTE: Some institutions enter into contracts with contractors to perform ongoing electrical work at an institution,similar to institutional employees. If,by the terms of such a contract,you direct the performance of such work,include the num- bers of such employees in this application. If the contractor directs such performance,of if the contract period is for less than one year,application must be made by the contractor on the standard form for such work. Do not include such em- ployees in this application. Please give your official title,such as"Director of the Physical Plant"or"Director of Facilities"or equivalent. In addition, provide a statement that substantiates your authority to hire electricians pursuant to c.141§8 for electrical work on the prem- ises of your institution,and to establish priorities for the performance thereof. This form is not to be construed as a grant of authority to direct any licensee of the Board of State Examiners of Electricians to perform work in contravention of the rules of said Board,or in contravention of the Massachusetts Electrical Code. My title is: My authority to act for the aforementioned institution is: I certify,under the pains and penalties of perjury,that the information on this application is true and complete (Signature) (Dated) 3012 y (Print name) 'St�v 1-N uc1^e.-✓.- (work telephone number) (extension) (facsimile number) I LvS`7 VI. G.iL L` Un..IA `ti LvL'"1-A-( �jti Sw•AU .i,GtIVCSI i S 4 tsT hn-t-�l ` d-v."CL�I^' Yw�1...c..C. < W I t I h'�i �`i(t_.F U R.rv�c'� 'k-ks.- �t S iwG-E 5 • cAl_..G€-Kxcr-4 I CCU I.rtL t 'WV ''p 1^-'• �ti� wt .l ��lA/k