Loading...
HomeMy WebLinkAboutBLDE-19-002361 ��� Commonwealth of Official Use Only Er Massachusetts Permit No. BLDE-19-003261 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked VRev.1/07j 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:11/28/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her Intention to pertomi the electrical work d i.gdbylow. Location(Street&Number) 300 BUCK ISLAND RD UNIT 2C d_. L Owner or Tenant SULLIVAN VIRGINIA AUCIELLO elephone No. Owner's Address SULLIVAN THOMAS P,300 BUCK ISLAND RD UNIT 2C,WEST YARMOUTH, MA 02673 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 HVAC. 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 1 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- a 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. 1 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 ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:' No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters Siens 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 0 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 oa IN ` z I �� t t l�a�c�cf1 Of sial Use oay Z� p u i W _ c7 e7 (7 Perm:01:7 e. CDC IS ' �L.JeP¢rrasr�o{.y+r/...Jervicei.... `" is BOARD OF FIRE PREVENTION REGULATIONS OccaChecked w �2ay. •— -- Ill tv p [)cove bleak) v > I APPLICATIOtie FO.R PERMIT TO PERFORM ELECTRICAL WORK Z .4ll wortto (j� Z �o IP-r���m a^evr3aace wi'�ire Mzcsachuse¢s Elecniea!Cale(ME ,527 CI r 12D0 0 �, (PLEASE PR➢JTINTKORTIP 4LLINFORGATIOTJ Date: /i _J�to t City or Town of: YARMOUTH To the Inspector o Wires: By this application the lmdersiped rives notice of his qor her intention to perform the Tec cal work described below. • Location (Street&Number) __ Q© /4 - t — 0 -7 CV Ir (.....----....\\ Owner'or Tenant 6a/ / ' / —�L/�� Ilii✓ Telephone N. 7 z',73.0—/ Owner's Address true_ Is this permit in conjunct-1 with uilding permit? Yes �' / P ose of Em din; e �' ❑ N✓L`L (Check Appropr ste Boz) �`' ��— Utility Authorization Na Eustiag Service/Qa gimps /,2o aqa Volts Overhead '''..s__ New Service EtUndg No.of Meters APs / Volts Overhead IDndgrd ❑ NO.of Meters Number of Fe_ders and A mpacitya_ kep elf Location and Nature.of Proposed Electrical Wort: /„s•, ����1/2�f�'CP�_ �o�� Pi1�7SE?!L Conviction meth,foflmi st table may be waved by the Iryy.-nor of n vee. No.of Recessed Lam .e Na of Cefl Srsp.(Paddle)Parts INo.of Total _ Trzasforraers KVA No. of Lam: Outlet No.of Hot Tabs • Na of Lami G•-nerafirs • ECVA ' aau'-s SwMnn*ne Poole o d. El 'Batter!Unit; No. of Receptacle Outlet No. of OE Burners 'FIRE ALARMS INo.of Zones No.of Switches Na.of Gas Btu nets ria.of Detection and InitiatinE Devices O Na. Tons of Air Cond. Total IND.of Alerting Devices No.of Ranges No.of Waste DisposersHeat Pomp I Number Tons I K W Na of Self-Contalaed Totals: I IDeteelion/Alert uia Devices No. of Dishwashers Space/Arta Heating KW Loral❑ Mardcip?L Coanecton 0other No. of Dryers Heating Appliances KW Security Systems:* No.of Water m KW INo, of No.of Na of Devices or Equivalent < Bal Data Wiring Signs D No.Hydromassage Bathtubs INo. of Motors Total RP Telecommunications Winn;, OTHER Na of Der2ces or Equivalent • • Estimated Value of Ele 'cal World Attach additional detail if desired oras required by the Inspector of Wires. I Work to Stan / /S' Fd i nccdad by=mi. C policy.) Inspections to be regncsted in accordance with MEC Rule 10,and upon completion. INSURANCE C VER. GE: Unless waived by the owner,no permit for the performance of electrical work (� the licensee provides proof of liability i issue C Theunless llty nsurance inclnriing"completed operation"coverage or it substantial equivalent \ undersigned certifies that such coverage is in forte,S has ahrbited proof of same to the permit issuing Oct. D CHECK ONE: NSURANCE Ir BOND 0 OTHER 0 (Specify.) I[RM ander the p and p • of ,that the in on-on on this app&uo n is trite and complde FIRM NAME: call: �� LIC.NO; fj90 Licensee: �.v , i_' Signature LIC NO.• afapplimbic. enter empt"in the license b line) Address / , ,,/ c' diri. c. I etailt AG. Bus.TeL No: _l `Per M.G.L. e. 147,s.57-61,s--..'ty work requires Depatment of - .lie SafetyAlt Tel.No.: )•///�%(// OWNER'S INSURANCE havet eica liability Liaecov �c WAIVER: I am aware that the Licensee does nor the insurance coverage required by law. By my sigaatnre below,I hereby waive this requirement. I am the(check one 0 owner t Owner/Agent ❑owner's 01 Stgnatare L Telephone No. PERMIT FEE: $ V