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Home My WebLink AboutBLDE-19-000991 Commonwealth of Official Use Only fit Massachusetts Permit No. BLDE-19-000991 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/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:8/20/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to petition the electrical work described b , v. ` Location(Street&Number) 1 FILLMORE RD ( kr J d Cv Owner or Tenant JACKLES FRANCES M Telephone No. Owner's Address 1 FILLMORE ROAD,WEST YARMOUTH,MA 02673 Is this permit in conjunction with a building permit? Yes 0 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 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ ln- CINo.of Emergency Lighting Rind. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners - FIRE ALARMS No.of Zones - No.of Switches No.of Gas Burners 1 No.of Detection and Initiation 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/Alertine Devices No.of Dishwashers Space/Area Heating 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 Siena 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 lamonruaalt6 o/11/ai4aeLafli Of—neiel Use Only ,...i [ t /e7 r, Permit No. • BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,' �� 'Rev. ]/07] (leave blank) tit APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1200 (PLEASE PRINT Thr INK ORTYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Inspector of Wires: By this application the mdersigned gives notice of t or her intention to perform the electrical work described below. ('If Location(Street&Number) ,...iC j/Jmsm_ Ree stayt Owner•orTenant Lipq/s'gt C"a/,✓s ,,, Telephone No, Owner's Address �( S Is this permit ilin conjunction with a b ding permit? Yes ElNo� (Check Appropriate Box) PurposeofBudmgs / / Utility Authorization No. l///►st ' Existing Service/OD Amps 41 a / , Volts Overhead Undgrd❑ No.of Meters _Z__ New Service _ Amps / Volts Overhead S Undgrd ❑ No.of Meters Number of Feeders and Ampacity .. e • ovation and Nature of Proposed Electrical Work: Iii bit S. Al4” I>I N I li .. ._. __- _. _ . Completion ofthefolfawine table may be waived by the lnroector of FPars, '! i 'I2 No.of Recessed Luminaires INo,of Cell-Stmt,(Paddle)Fans No of of Tota! w h Transformers ICVA LU 10 it No.of Luminaire Outlets INo.of Hot Tabs Generators • ICVA �n lc?. Ii ` =- I Na.of Luminaizes (Swimming Pool Above 0 fn- 0 I a.or tmergency Lighnng - fll '� erttd. ?nsd. BattervIInits 'j T� No.of Receptacle Outie�s No.of Od Burners m s 'FERE ALARMS [No.of Zones No.of Switches No.of Gas Burners No.of Detection and • Initiating Devices No.of Ranges INa.of Air Cond. 'Tons( No.of Alerting Devices va No.of Waste Disposers Heat Pump Number fNo,of Self-Contained Totals:I I_Tons I KW .Detection/AlertinE Devices No.of Dishwashers Space/Area Heating ICV ' Voce Q ConnMunicipal ection other ® No.of Dryers (Heating Appliances 1CW Security Systems:' No.of Water No.of No. of Dam o.of Devices or Equivalent — Heaters Sins Ballasts No.of Devices or Equivalent Z No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: t Na of Devices or Equivalent OinER Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of al World 77 (When required by municipal policy.) Work to Start: 7 t Inspections to be requested in accordance with MEC Rule 10,and upon completion. knINSURANCE C a ' • GE: 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 V BOND 0 OTHER 0 (Specify.) I certify, ander the pains mr�penalties of per]ray,that the information on this application is true and complete, FIRM NAME: pe5 ,190-g(cor--S LIC.NO 0b Licensee:,>j� 4 M _o^y4 _ Signature ,.... .1-47.4 :2410"..7— LIC.NO.a(IlaPP hcab7renter "tempt^'n the license mrmber r Address, 27 /3 l 141-'fns' ,e__ /9�,a„r 4/c Bus.t TeL No J 'Per M.G.L. c. 147,s.57-61,s eurief work requires D art hent of PubliippSaf Alt Tel,No. 9u ep ety"S^License: Lie.No. — 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(check one)0 owner D owner's agent Owner/Agent Signature Telephone No. I PERMIT FEE: S