HomeMy WebLinkAboutBLDE-18-001532 " Commonwealth of Offld1 Use Only •
Massachusetts Permit No. BLDE-18-001532
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.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:9/18/2017
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to Friona the electrical work described below.
Location(Street&Number) 317&319 CAMP ST
Owner or Tenant HARWICH ECUMENICAL CNCL FOR THE HOMELESS Tele ho 14 /
Owner's Address P 0 BOX 86,WEST HARWICH, MA 02671 n{,&/z„si
Q
Is this permit in conjunction with a building permit? Yes ❑ No ❑ gyp. n plq►�/ J, , /
Purpose of Building Utility Authorization No. 1 ' �l_/1V/ T/,®
Existing Service Amps Volts Overhead 0 Undgrd 0 . 0 / /
New Service Amps Volts Overhead 0 Undgrd 0 No.of
Number of Feeders and Ampacity _ ... - - - ' �m
Location and Nature of Proposed Electrical Work: Replacement furnace(IN ATTIC OF UNIT#309)
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 0 In- 0 No.of Emergency Lighting
gird. gird. 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
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/Arealleating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:"
No.of Devices or Eauivalent
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 IIP ,Telecommunications Wiring:
No.of Devices or Eauivalent
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:1 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
WA 1(t4(7ra,
en D."r"rs1Js of ii/astechc3rJ! e�tl1Z
_ 34, apartn.¢�.J`ire S'ooixi :Pecan No.
7n�
:-.4` BOARD OF FIRE PREVENTION REGULATIONS Oma'ancy and Fee Checked
• Rey. 1/07] • pez a bin±)
APPLICATION FOR:PLRM[T TO PERFORM ELECTRICAL WORK
/ All wart to be performed in accar3m¢ I�
-A
with the ssa Electrical Code c.for $27 .• t 2D0
�i U (P PRINT DV MK. OR T7PEALL INFORdt4Tyoh9 Date: — /s 7
City or Town of YARMOUTH To the
eill . By application the nsp or of^rtes: .
lIIde?ngned;i es notice of bis ca her intention to peat=the desmbed below.
Location(Street&Number) T I 7 • p S� ce4.v i �J f3oi
Owner'orT Tenant
/
AiTr- Is
// Telephone No.
Owner's Address --�__
this permit in conjunction with permit? Yes permYes ❑ No ❑ (Cher t.4ppr•opriat°Box)
• Purpose of Bffiti• g c:A.AJ � Vasty Authorimmtion No.
Easbn:5trvic- Amps / Volts Overhead Q D0
ndgrd No.of Mtzs _
New Number i e Amin / / Volt Overhead 0 U.-• • 0 No.a hf
® ' �d os
d Ampatitp , , so • I li fAtPa, C
� et�iml Worst
. Completion of the
re tr No.of Raaswl i r,...tner.. Iwo.of Cel.-Sosp.(Paddle) fe�awt+�ia• tzszfo be waived by the Tlra�yor,fp'au
w
c:5:4) W I No.of Lamin:• -Orates No.of Hot Tubs ��nts .rrir
I'C'A
� o ( IC�ssama >iVA
V O • No_of Lames IS Pooi Above In- tvo.m i�.me�acy l+t.va� -
w al Na.of Receptacle Oaf INo.of Off Framers
_ ALARMS IND.of Zones
CC ;; No.of SwitchIND.of Gas Emxa s • 'No-of DenIIon sad
mm
•
In111Lt a Devices
No.of Rears No.of Air Cond. Tnn�s No.of AIxtin Devices
V No.of Waste Disposers I sTotals:
.2.=_L _.
ons I ' i`a .; .
V ... . on. .. .
• No.of Dahwrshrrs Dets¢on/4t.rwye Devitrs
IspamlAa n Hearties KW Leal Q Cq moa 0 Other
• �+ No.of Dryers Imo'Appfeznea KPV Secaritf Sista.11*
No.of Water No,of bgvim or Eq est
FCVJ No.of No.of
® Heaters Signs Ballasts baEatofDe
No.of Devices or Equivalent •
No.Hpdromassaee Hathinbs No.of Motors Total Hp Telecotttmnnitatiou Wumr
•1 OTHER:
No.of DOTI=or Equivalent
i1
��.��� - "Mach additional detail rfdeut4 Dr m reed yy the t
Estimated Value of Electrical WorE 2 7,.? a (Whenuxuw of Wires.
Work to Start ���municipal policy.)
INSURANCE COVERAGE U� �to be recurs-lid in accordance with MEC Rile 10,5 upon completion,
tail the licensee provides waived by the owner,no permit for the performance of electrical wort may issue unless
• ' undersigned proof of liability insurance including"completed operation"coverage or its substantial equivalent The
gned certifies that such coverage is in force,and has abrbited proof of same to the permit issuing ofince.
CHECK ONE: INSURANCE g BOND 0 OTHER 0 (Specify:)
ro T tn4IRM she p �penalfies ofpsf ay at the i nformz on on this appEedian is true out comply
1 NAME: Co/24Uo,�1d_f'c} rdthleeM,c cart/C tic NOe
O Licensee Cyg Co acted S'tgnatare
( cess: le.enter : .. -!n the lteou 1 i-teeeit-1 4/SZ.
/
Address _ 7 rrf/ q / Bos Tel NaNo.
j Per NMI;c. 147,s 57-6 s• .'Sy work _.... _ Department of •lie SafetyAlt.Tel.Noy- �.L
OWNER'S INSURANCE "S"the Biba c Lia No.
`¢ required �. $NCE WAIVER: I ton aware that the Licensee does not have liability insoream —
I Otvar Y my si�atnre blow,Thereby waive this rsquuemeat i am the eDverage aOh'
• t.
.t Ovra cin-enc (rhect one) scone ❑owede.e._
•\) Trienh"".N.. rsnoxrrr ens_