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Home My WebLink AboutBLDE-19-005752 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-005752 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:4/16/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 572 ROUTE 28 ' (c ( fDQD `�t_/Owner or Tenant RICHARDS SUSAN J TRS Telephone N6. Owner's Address RICHARDS PAUL K JR, P 0 BOX 90, ESSEX, MA 01929-0002 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: Change receptacle for stove. 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 ❑ In- ❑ 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 No.of Gas Burners 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 ❑ 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 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $80.00 �\,. U� IL0` ;,...„,0 ,,ck � 1 V l�oinmo►iwaatth of///assay fti Official U e Only V �i_- =/ 1JaParfm¢riE oi.yiro Jarvius Permit No. Cl5Z ---:::-Av 1 === T=_ ' Occupancy and Fee Checked - BOARD REGULATIONS OF FIRE PREVENTION REGUL e 3 '�'` [Rev. Uri (leave blank) - APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code WORK ' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: )'Sri/ti CMR _ City or Town of: YAR1VIOUTH f • O V To the Inspe for of Wires: By this application the pndersigned gives notice of his or her intention to perform the electrical work described below. - Location(Street&Number) _ 7 �..�X- � Owner or Tenant """, v � tE �e /r Telephone Oar Owner's Address 8� ��104140 o� T� hone No. ii Is this permit in conjunction yilh a bui7din p Yes ❑ No� (Check Appropriate Box) Purpose of Building < _bet e �! G�� / / Utility Authorization No. Existing Service,4 Amps/7e / Volts Overhead Und grd❑ No.of Meters New Service Amps / Volts Overhead Un d gr ❑ No,of Meters Number of Feeders and Ampacity �. tna .� k Location and Nature Proposed Electrical Woi G!/S i.4J 9rAfce CA)0 e Completion of the follcnving table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Snip.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ElIn- No.01 h mergency Lighting - ernd. an, ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners Fi E ALARMS JNo.of Zones , No.of Switches No.of Detection andNo.of Gas Burners Initiating Devices No.of Ranges No. of Air Cond. Ton No.of Alerting Devices No.of Waste Disposers Heat Pump I Number!Tons I KW No.of Self-Contained ' Totals: I f Detection/Alerting Devices ® No.of Dishwashers Space/Area Heating KW' I,�❑ Municipal Connection ❑ other No.of Dryers Heating Appliances n Sec No. Systems:" No.of Water No.of No.of Devices or Equivalent Heaters KWNo.of Data Wiring; ^ , Signs Ballasts No.of Devices or Equivalent L ) No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - OTHER: No.of Devices or Equivalent Attach additional detail if desired or as required by the Inspector of Wires. I (When required by municipal policy.) Estimated Value of El 'cal Work: .� ,Work to Start: ' r Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO 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. J BOND 0 OTHER 0 (Specify:) f certify, under the pains an een'alties o ) P f perjury,th the '``formation on this application is true and complete. / --��99 b FIRM NAME:_ 4)"�E% G %n� - f sa7d Licensee: � " LIC.NO.: (If applicable,enter empt"in the license number li Signature LIC.NO.. Address: 7r iL -/ Bus.Tel.No.: ,j Tel.N*Per M.G.L. c. 147,s.57-61,s uri • work requires Department of Public S. ety"S"License: Alt Lic.No.' ,zt- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner E n— o- Owner/Agent ❑owner's a ent Signature_ Telephone No. PERMIT FEE: $