HomeMy WebLinkAboutE-07-105 #82 Electrical PermitsCommonwealth of Massachusetts Official use only
Permit No. r d%y lUi�
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS . 11/99.j ve blank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All wadcto be performed in axordance with the M=schusctu Electrical Code (h=), 527 CUR 12.00 ` )
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: -7-
Co
City or Town oh YARMOUTH To the Inspector of Wires
this application the undersigned eves notice of bis or her intention to perform the electrical work described below.
,tnc�a treet & Number) MILL pOND VILLAGE., 121 Cate St Bldg #_ZY 2�
o Owner
ti O7rer
If (-'D
CA Q
•
Tenant Gatewood Homes/ Jeff Sollows Telephone No.508-7789669
Address .1600 Fa]mouti Rd., Suite 25, Centerville, Ma. 0263.2
rmit in conjunction with a building permit? Yes X❑ No ❑ (Check Appropriate Box)
of Building single family residence Utility Authorization No.
Service Amps / volts Overhead ❑ Undgrd ❑ No. of Meters
vice Amps / volts Overhead ❑ Undgrd ❑ No. of Meters
Arber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work Fire Alarm System (low voltage control panel)
wi h backip battery, centrally monitor
('a 1,,t Fnn ofthe followine table rnav be 4ed by the Inspector ofWims.
No. of Recessed Fixtures
No. of Cell. -Sus P . Fans
(Paddle) )
°• of oral
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool d e . ❑ d.
ot Emergency g
Batte Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE.. ALARMS
No. of Zones -1-
No. of Switches
No. of Gas Burners
No. o Initiating Det ng D .an 7
evices
No. of Ranges
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Totali:
. Number
Tons
Detection/Alertin ntainDevices 7
No. of Dishwashers
SpacetArea Heating KW
Local Municipal icipti l ® Other
No. of Dryers ..
Heating Appliances KW
Security ystems:
No. of Devices orE uivalent
o. of Water KW
Heaters
o. o o. o
Sim Ballasts
Data Wiring:
No. of Devices or Equivalent
No. H drumassa a Bathtubs
y g
No. of Motors Total HP
Tclecornaunacatlons icing-,
No. of Devices or Equivalent
OTHER
Attach adadonai detau y destre4. or as required by the Inspector of wtr=
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 (MBOND ❑ OTHM ❑ (Specify-)
cpuation Me
Estimated value of Electrical Woric $ 750.00 (When required by municipal policy.)
Work to Start Inspections tobe requested in accordance with 1viEC Rule 10, and upon completion.
Icertify, under thepains and penalties ofperjury, that the information on this application is true and complete
FIRM NAME: Baltic Security, Inc LIC. NO.: 1178C
Licensee: Jonas R Bielkevicius Signature - -' " LIC. NO.: 499D
(jfapplicable, enter "exempt"in the license.nwttbe . •. Bus. Tel. No.- 508-.833-0996
Address: Box .�.609 Sandw c 02563 Alt Tel. No.: 508-71 -3 47
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 (cl=
Owner/Agent
Signature. Telephone No.