HomeMy WebLinkAboutE-18-4635 Commonwealth of Official Use Only
titMassachusetts
Permit No. BLDE-18-004635
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
(Rev.1/071
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:2/16/2018
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) 95 HEMEON DR
Owner or Tenant HOWARTH WILLIAM E Telephone No.
Owner's Address 95 HEMEON DR,WEST YARMOUTH,MA 02673
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement boiler.
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 ElIn- ElNo.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
Toil
No.of Waste Disposal Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Cleating KW Local 0 - Municipal 0 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 Enuivalent
No.hydromassage Bathtubs No.of Motors Total IIP Telecommunications Wiring:
No.of Devices or Enuivalent
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 ❑ (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
(Ifapplicable,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
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BOARD OF FIRE PREVENTION REGULATIONS ��and Fa tleckea
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APPLICATION FOR•PERMIT TO PERFORM ELECTRICAL WORK
All wort tobepsfvmedinaccords=.rithd Idassatinstes ElectricalCode 527 GAR12DD
(,\ i1 (PLFiSE PRAT ININKORTYPE ALL A'FORML770NJ Dates
(ftp or Dem of: YARMOUTH
By this�l?�tion the To the Inspector((Fres:
rer:
Q London pbcati(Sann poderj oftis• r her oa m pert=de electrical work described below.
1" I l\ I
Owne orT t ' e��7 / i/e
Owner's Address ��,�/ o �'7/e. Telephone Noes- 9363
Isthis itmit/aconjunct% with gpam!<? Yes
o P impose of Emldnzs �( Q ty de. (fon No. yrs oPriatz Boz)
�` IIhEtY Aathoriatioa No.
W co Ezirtlag Service/6ra Amps /.24 Otto volts Overhead Q Undgtd❑ No.ofKts
`,'+ N New Service Amps I Volts Overhead❑ U,
• •• coo o Namba•of Feeders end Amp dtf A 0 N'of hers
O�P.GII i� 4 • -
V k ' c' Location aid xanre of Proposel KleC rieel Watt f
LWT.. O' Am.�j�'� /I
w J
C m m Na ofReeetsrd•yesosp. _ .......
v ct.rd
dihaye�•
Na ofIamfasfre O¢xI� 9 (Paddle)Facer •
HotTobs Gsae>ats • SPA
Na.• ofL Swti w tn;Pool snoia 0 ernd 0 a Vets :
No.of RaQptade Oat- • 74o.of OR Ruiners •
ITEM ALARMS 1Na of Zones
Na of Switches Na of Cm Et-mess l-ta oof DevicesDs __andd
' ... L• •. •. . ntdsen
Na of Ranges No.of Air Cond. Thus Na gr ttin Dedses
No of Waste Disposes
Totals
, II '- ons o. v.;•
• Na of Dfshweshets � Dever _
9 SparlAtea Hn6n' KW Local Q mnICo>nu ❑ Other
• - No.of Dryers (
No.of Water Nom:Appliances KW Security
of Devices or Hgnfvaleat _
Heaters KW Signs of Ballaao. stS Ylab Wiring:
1 No.Hydro/Dissect Bathtubs No.of Motors Total HP feecomonwatunts
OTHER: No.of Deices oi-t i iswhi~_,
..v./ _ •
testimated Value of�+-. Wow e?T (When by paint(or ar 1h the Inspector tint.
Work to Start a- - /, Inspections to be pule 10
LNSIIRAhiCI% v n9o�meccerdnneewhLMECRnIeIQaDdnponmaap(epos
• %oh VBRAGL Uo)esswaived bythe owner,nopermit far t the
performance the licensee provides proof of operations'
4a�t»banx ofelectricalsub al work may issue
13 unless Lability insurance iactadmg completed !bels
utgned dcetifiesthatsnub coverage ovis in
AID X01dbas��proof of sconeto pmmtissuing office.stantial=at
!be
INSURANCE 0 0 (Specify)
o I miff,ander the paler andpcnanfes ofpajarystkat the btfmrtdon'on&is applied=a true and complete.
PERM NAME: Go Q c)0&1/a.frg/ee-th c ,7t/c
Licensee UC NO• ��'a
AddresweippEros:
e.enter-- _ In the limn , ape/ # edliJ
address : Pi/ 4 l "✓e aos TeL x
Tel.N
J 'Ter MOS–x147, .$76 , .._ • • • Dep�eac . ..ties
OWNER'S IT! ` u Safety � a
rewind by law.g x�WAIVER: I an nue waive
this
Liemtr does not have�e 5
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