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Home My WebLink AboutBLDE-19-002362 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002362 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] 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:10/22/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 19 JACQUELINE CIR Owner or Tenant KIMBALL MARK W Telephone No. Owner's Address KIMBALL TIMOTHEA K, 7 FERNWOOD DR, EAST HAMPTON, CT 06424 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 ❑ 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 furnace. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) No.of Total 'Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. 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 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 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 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 ❑ (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 1t ( 2, (1 ? (L eDdJ z/ee/(47 2fI3(( ie-Cceer Ito( t/A- //4/tl e ( -,ity0 • • _ t.om.raar� //Di ... fit - OLGeial Use only "i� f c 0. 23 1 • �sTie F.rr..zd c�,7re scrci=e3 Permit No. =, ,_ BOARD OF FIRE PREVENTION REGULATIONS Occup�`�'and • Fee Checked l� (leave bleat) -_ .5A APPLICATION FO. PERMS" TO 4ltwort mbc 0 PERFORM ELECTRICAL WORK in a with 111e Mz acb Or (Pi&SE::MINT 1NWC OR TYPE ALL DI F'OP 4J7ON) -�y__se _. Date: 527ectrical Code c no YARMOU'1'b City or Town or To the Inspector of Tres_ Locationthis application the o .a,;fined rives notice of his or her intention to ..0: . the electrical wed:described below. (Set number) C `1 C,' ~.1 ill \ ( Owner•or Tenant C. /d r Owner's Address Telephone No. Is this permit in conjunction with a harm.;pal Yes ae Purpose of Etnlam; �j,P ❑ N0 /� (Check Appropriate Bar) UaTty.kuthorizaton Na �Service.21..)Q Amps / gar or Overfiead �� Fr IInd,Qrd❑ No.of Mfrs �,z New— den s uj, I: Numbs of P / Volts Overh d Undprd 0 Ito.of hiders LU Q �dss n rid stsrtp f K-�._ ��,e i ei' _ m Location d N= _of Proposed R1-• ricai Work )---- r.' �s� tlr am'�c/ 64-te t T !-- Z � 1 Caarpletian oft a oIowirt•,table myy be waived' tie Impactor°Mi i 0 e '- .D No.ofR_-caste I�.,,,;,._:., a ® r�, , INo.()WPC pF►-Sup-(Paddle)tTaas • a o= b'V. _, 1, No-of Lu**c re l Outets I - KVA - �__.:a.._..._._;;c '. II�o_�fHotTtths _... ...�..._-, • No.of Luminaires Iswizatbig Pool °_bove Its .otaett of y Unils . Prod-. snd. ❑ E, s II No.of R.ec e Q Y,� ti p INa of On E ners TAR„ALARMS Na of Zones No.of Sig No.of Gzs!homer •s zion No.of Ranges • Total t Devices v Na.of air Cond. Tuns No.of Alm-thig Devices No.of Wash Dispos Ht&Pomp Number (Tons I KW No..of pelf-Couta d-" 1 l No.of Dishwashers - D na/Alertca'Detzm _��. Space/Area HeatingKW Loczl al No.of D Q Connection ❑ o V ma's Hearin Apptiant�s ��, ecvrifp Systems:e o.of afar Na of Devices or tiquivaleat �� Heaters KW o.of no.of i a Rdnog: ' Si*ns Ballasts Na of Devices or ni lent ` No.Hpdrotnassage Bathtubs No.of Motors lotion) Telecommunications trintr 4 OTHER: Na of Derit:es oi- cleat Estimated Value of E Attach oddititmai derail if dg:sired or m required by the Insp�tu of Wirer. to Wort` lJ (When requiredby municipal policy.) vt Work to Start el ) Inspections to be requested in accordance with MEC Rule 10,and upon completion, ' INSURANCE CO R4 E: Unit-cs waived by the owner,no b the licensee provides permit for the performance of electrical work may issue. t�, P proof of ltab Ay insurance insurance inchidmg"completed operation"coverage or its substantial unless undersigned certifies that such coverage is in force,and has exhibited equivalent The --� CHECK ONE: INSURANCE BONDproof of same to the permit issuing once 0 OTHER 0 (Specify) I cam,under the pains and penalties of erjary,that the iriformatiori on this 1 FIRM NAME: �a7 � e ape anon is flue and cornpkre Licensee: LIC KO,: O "in the • e number tine) � LIC Np; (7fopPlicable eater" Srgnatare Address: f /"-' - Bus.Tel.No, "Per MLG.L_C. 147,s 57 ,s work Department of Public SafetyAlt.Tel No. OWNER'S INSURANCE WAIVER.: "s"Licensee Lie.No. - required by taw, boa iE I am await that the Licensee does not have the liability insurance coverag -t Owner/Agent By my n hereby waive thisrequirement I am the(check one ow a nO�IY Signature. owner's �1� Td�nhnr•?Jr. ATe Acrrr Cnw_ ..