HomeMy WebLinkAboutBLDE-18-003529 .),,a0—%
Commonwealth of OtlicialUse Only
Massachusetts Permit No. BLDE-18-003529
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Tev.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:12/16/2017 •
City or Town of: YARMOUTH To the Inspector o Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. /�
Location(Street&Number) 503 ROUTE 28 (TlJ(] �..
Owner or Tenant 1� „' `TelephoneNo.
Owner's Address _
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: Exterior complex lighting.
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
Transform' 0 KVA
No.of Luminaire Outlets No.of Hot Tubs Genera KVA
No.of Luminaires Swimming Pool Above ❑ In- 0 No.o c t' g�
god!
grnd. Bette i
No.of Receptacle Outlets No.of Oil Burners FIRE AL Sop//off�i 1I
No.of Switches No.of Gas Burners No.of Detection / `'r((__AAVV//J
Initiating Devices ((
No.of Ranges No.of Air Cond. Total No.of Alerting Devices ��C///
No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained 4
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other:
Connection /7/
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent >
No.of Water KW No.of No.of Data Wiring: J/
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 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$80.00
r: /41./vis s& . -.... otsciaust Otir
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J il PBOARD OF FIRE PREVENT!.
REVEN ION REGULATIONS ��Ind Feed
�°'� ______12..tleerelurt) ��'
P11APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
INI 1Ilwoittohepreformed mats nith dr Messechoess Bratical Code 527 12.00
"1tt�
� f efri, (PLEASEPRINT 11.1 -OR=ALL INFOJtTM Date
Cltp or Town of: YARMQ(jTH To thelnsperlor Furs:
. By this application the[nrderfigoed ems notice ofhis it her illation to perform the electrical watt described below. •
ti IL" n &N ) 7 3S '�1t,L/ Or►ner orT t „ A Pt 4 Ce i 1a gilts'clic al 1 ni Telephone No.
���' Owna's Address ----_�
Is rids permit m costanction with a bniZdmg permit- Yes 0 No ❑ (Check Appropr'iat:Box)
Purpose of Bviidmg '°:;,,iCesS r;".,vii P1z o tit*Anthorntion Na
•
Exist' fag Service/40 Amps/.2d b?'U Volts Orertead 3' Uad r•df No.of hret s _
Jlew service Amps / Volts Overhead 0 Undgrd 0 Na.of Knee
Number of Peed=and Amp city ,__,44., Al, ' •-f Al .
:onaad of sled
Nil—
r.
- '/1.- /' ` 2 ref a . Cr ,
.`
10.otRecessed
_... tae'..,. .. mMs.',- bevat�d . icy
--•• s1iFr'et
I o.of CerrteSosp.Toddle)Fos o.
a."ft_�er:Oudts I . ofEetDubs KVA
oft enter: Crseraina • gVA'
No.oft .root aaadte 0 tad. 0 :Cot -- _ ■tea .,:
--
Na.of Receptacle OtSeaa 1 a.of OH Baxaees _ I..re ALUMS Ia of Zones
No.of Satan a.of Gas Rraeers a of Dina and
I o.of a.of Air Coad. Totottlesbut Devices
ns 1-a,efAL"rtfv Devices
a.of Waste Disposers I Tot:>s
I Devices
000 I o.of Db:fiwasbers 'Spate/Arm Haan w- „r t a eo> Doer
. _ o.of Dryers Elwin Appfixaaes
t o.of Water IOW �Na of _"r>rGnivalmt
o _
Heater
Kw
of
Ba off a res Wang,
Na of Devices or „.
lad Mo.Hydromzsnge Bat/tabs l o.of Motors Total H? - mmos,htim �� �
Na of Devices ozEgniraimt •
OTHER: _'
•
Estimated Woe of cal w /,-�dQ, Aso:A detail Pedantic(orw required by the hupeektof Wires
imtedW �j:9 (�siredbrmaniapaipobc9•)
Work to tarttCSJCYi, 6itA myons to beregoesstidrnacc ewithMECRtle)gandupon completion
V1 GL t)olesswaived bythe owner,nopetmitfor t e
t1 the licensee provides proof of liability insurance' feted 4 its
lent These
� operation"coverage or
ea undersigned certifies that sod,coverage is in fine,and has abibited proof of see pemut substantial
equivalent The
ce.
4 CHECK ONE: NSURANCE g BOND ❑ mita 0 (specify)
o henry,ander the paha and penalties ofperf ry that the bnrforardon'an this applka¢nn a tree mrd eomptet.
FIRM NAME: Gogo oaJd_S taridiea>`r'i e. „�t/c LIC.NO a 2 j d
Licensee a - • Co , ,
Ww'pt e;ave ;a de lima , tare —ISL N . ;6�//
Address: _ 7. hi/ h 4 el tfe 4,0 f IeNO�I r Baa TeL N • --rim
J `Pet MO.L.a 147,s.57-6 , .._ ,• weak Alt TeLUt.N '
� INSUOWNER'SITr .be$ YveTheaasc lia=r
RANCE I�aaare�theLiceaseadoalwrLavaE+e6 �-�---�.
I int • Eh/m'signorine below.I hereby-wain dais reguIrsmmt I em die(i t�p i]owners