E-19-1133 ' Commonwealth of Official Use Only
op
�• ;,, Massachusetts Permit No. BLDE-19-001133
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:8/24/2018
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) 31 SPRINGER LN
Owner or Tenant SPITZER WILLIAM F Telephone No.
Owner's Address SPITZER ANNETTE M,281 VEGA ROAD,MARLBORO, MA 01752
Is this permit in conjunction with a building permit? Yes ❑ 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: Replacement furnace
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 1 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 1 No.of Gas Burners 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
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 No.of No.of Data Wiring:
Heaters 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 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Gary L Gordon
Licensee: Gary L Gordon Signature LIC.NO.: 15290
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:37 BILLINGSGATE DR,DENNIS MA 026382234 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
signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
S(2-f-t( (e
•
air l.ommpnroca1t o�c7 ¢6a��oai< clti UsSOnlyf�' �j
. Zeparfincnf 1 giro...7crvicee .Permit No. 1 ' JJ
riff-
' BOARD OF ARE PREVENTION REGULATIONS ev. 1/07) (l Fee Checked sd�
ev. 1/07] (leave blank) -----
APPLICATION FOR,PERMIT TO PERFORM ELECTRICAL WORK
6 / All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 ClR 12.D0
//�(/—"j (PLEASEPRINT ININ OR TYPE ALLINFORM4TT0N) Date: 'rAa&/ ix'`
/ City or Town of: YARMOUTH To the Inspect r of Wires:
r (,J r . By this application the Etndersigaed gives notice of his or her intention to perform the electrical work described below.
1 Location(Street&Number) 3 1n J
r/,dM1/(//�_ I Owaer'orTenant WILL/ 9?JTZ£r? TeIephoneNo. „ _S
Owner's Address /
Is this permit in conjunction wi a 6 ;permit? Sd. Yes ❑ No �7 (Check Appropriate Box)
7
Purpose of Building CIA". Utility AuthorizationANo.
Existing Service//l0 Amps/„Zei 0%Volts Overhead Undgrd❑ No.of Meters
0 ._i New Service Amps / Volts Overhead Undgrd 0 No.of Meters
�`—
_
Lu ` w Number of Feeders and Ampacity W f 2P aUe€41 A /.��� 2�Q�P
•
> m C Location and Nature of Proposed Electrical Work: r�s-L//��G7 '. 7" e Sell t /
a r`t/ IVY/
W - --- - _ - Completion of the followinz table may be waived by the Inspector ofWi rr.
V = i No.of Recessed Luminaires INo.of Cet1-Sasp.(Paddle)Faas No.of
Tot
Transformers KVA
U jJ ¢ o No. of Luminaire Outlets INo.of Hot Tabs Generators • KVA '
5 ;. .
m m • No. of Luminaires (Swimming Pool Above ❑ In- 0 No. air v Units cy Laghung -
arad. crud. IBattervIIaits
No. of Receptacle Outlet No.of Oil Burners 'FIRE ALARMS INo.of Zones
No.of Switches No,of Gas Burners -• •
Na of Detection and
•
Initiating Devices
No.of Ranges INa of Air Cont To -tal
Tons INC.of Alerting Devices
No.of Waste Disposers Aeat Pump Number Totts KW {{No,of Self-Contained -
Totals:I I I_ 1Detectio&AlertineDevices
No.of DishwashersSpace/Area Heating KW
(Heating Appliances Local Municipal
❑Connection 0 Other
No.of Dryers Security Systems:•
® No.of Water Noof No.of Datallo`. irinof Devices or Equivalent
Heaters Sits. Ballasts
VNo.of Devices or Equivalent
k No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail ifdesired or as required by the Inspector of Wires.
si Estimated Value of Ec Work 27X (When required by municipal policy.)
Work to Start c242-i5" Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C RfiGE: Unless waived by the owner,no permit for the performance of electrical work may issue
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent -mess
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify)
ta I certify,under the pains and penalties o perju,, the informatio on this eppffcatfon is true and complete. >���
t FIRM NAME: (5 g%✓,p e 4' �p ,q4 /e- a" LIC.NO.: ���-2� f
Licensee:pSignature a LIC.NOi� Z _C //
(If applicable, enter exempt"i the license numb r lin Bus.TeL No:
Address: Z �e/,j.2Jf�if �//e r Alt Tel.No /
j "Per M.G.Le.c. 147,s.57-61,s unity ork requires Department of Public Safety"S"License: Lic.No.
;-,-t OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
S required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent.
m Owner/Agent
Signature Telephone No. I PERMIT FEE: $