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Home My WebLink AboutBLDE-20-000343 o. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000343 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:7/22/2019 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) 24 WILDFLOWER VILLAGE `(-��E 1 it . ' EFL— Owner or Tenant Igiliiit=tettlimMittkielgOR Telephone No. Owner's Address ,24 WILDFLOWER,YARMOUTH PORT, MA 02675-1474 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: Wiring for air conditioner. 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 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. 1 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 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) 0 owner 0 owner's agent. Owner/Agent , Signature Telephone No. PERMIT FEE: $50.00 (ommori.uvatth o�t'r/assachu�atts Official Use Only dkij till4k2 I._ C2� /-0 � 3 ___=s__=' c7 n ��__= = apartmarr.t o f.lira J Permit No. Serviced (r = =—=� Occupancy and Fee Checked BOARD OF ARE PREVENTION REGULATIONS [Rev. 1/07) r (leave blank) clibti APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 5 /0 f ByCity or Town of: YARMOUTH To the Inspecto Wire : this application the'undersigned gives notice of hi or i ention to rform the electrical work described below. Location(Street&Number) r �eft.. 5'cAla Owner or Tenant filed liklit S'u'�- ee Telephone No. f/� Owner's Address j"� Is this permit in conjunction 'th a b " ;ng permit? Yes ��f�'"/Ts' i`i ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service/e9D Amps/9.0 o yei Volts Overhead ❑ Undgrcl— � No.of Meters New Service Amps / Volts Overhead (( ❑ •Undgrd ❑ O.of Meters • Number of Feeders and Ampacity Aga./ / i Lo donNature of Pro osed Electrical ork: l.` T/1 4,1I ea Completion of the following table may be waived by the Inspector of Woes. 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 Lighung - ernd.. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burnes FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and J • Initiating Devices No.of Ranges Total1 No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained `� Totals:I Detection/Alertma Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Conne No.of Dryers Heating Appliances KW Security Systems:* `'ta•+ No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: t.- OTHER: No.of Devices or Equivalent 4.J ctiCk- Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El tic 1 Work: 4/Y5.7 (When required by municipal policy.) Work to Start: 9' Inspections to be requested in accordance with MEC Rule 10,and upon completion. I INSURANCE 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 d undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER • I certify, under the pains and en s o 0 (Specify:) FIRM NAME: �'n of u ,that the in ormat�i n on this application is true and completes Licensee: LIC.NO.: /�� Q Signature LIC.NO.: of applicable,enter "es pt."' t e license number I' .) . Address. - r i X Bus.Tel.No.: Per M.G.L. c. 147 s.57-6I,s un work requires Department of Public Safe Alt.Tel.No.: ee OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n— o—ally required by law. By my signature below,I hereby waive this requirement I am the(check one ❑owner s egent 0 owner's a t Own al Telephone No. PERMIT FEE.