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Home My WebLink Aboutblde-20-001364 Commonwealth of Official Use Only Permit No. BLDE-20-001364 FED Massachusetts • 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:9/11/2019 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) 1106 ROUTE 28 Owner or Tenant TEDESCHI ROBERT L TR Telephone No. Owner's Address CIO DAVENPORT R/T, 20 NORTH MAIN ST,SOUTH YARMOUTH, MA 02664-3150 Is this permit in conjunction with a building permit? Yes ❑ 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement water he ysa ,, 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. 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 1 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $80.00 • r —--- - Commonwealth of Maddachtt! Official Use Only P-'- -__• ccam`. cc-'�� `� 7 / r� =/ Aparfns¢nf o,,}ir,Scrvires Permit No. W/ > fD " '`" BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rcv. 1/07J (leave blank) 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)pit( Date: City or Town of: yARMOUTH To the Inspector of Wires: --- ......_8y tllis application the undersigned gives notice of his or er intention to perf a elec 'cal work described below. r Locatigp (Street&Number) i 9i 4 !O<,,Owner;br Tenant a 1'l`;Z-e O K €�. r-- � � Telephone No. r.i Ov ei s Address ii 1,- Is `jis termit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) a. Popp- o e of Building ( et N K Utility Authorization No. Ezisti#g Service/�f Amps f l6 F PO 4 Volts Overhead ��ri Undgrd❑ No.of Meters / t Service Amps / Volts Overhead Undgrd . ._ I Q� gr ❑ No,of Meters -�-Nrtteaber of Feeders and Ampacity N� —4) , e ' ' !��•S` (84 Location and Nature of Proposed Electrical Work: .�►"' `� gerlitkreic 44:eite Completion of the followinvable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Situ.(Paddle)Fans No.of Total Transformers gyp, No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 'No.of Emergency Lighting grnd. crrnd. ❑ Battery Units 0 FNo.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 Total - 11- No.of Ranges No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons 1 KW No,of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Loral❑ Municipal Connection ❑ Other `,U No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No. of V Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent `C. 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. Estimated Value of Electrical Work (When required by municipal policy.) Nh Work to Start: !b Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE E: 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 O undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. Q CHECK ONE: INSUR.ANCE,� BOND 0 OTHER ❑ (S ci f certify, penalties o ) under the pains and f perjury,that the information on this application is true and complete .A FIRM NAME: �'_'O/e�0/./`t-:S'OIJ4'07ectr i L �(J LIC.NO.: 4/ 70 Licensee: -/j,y or ris, Signature • LIC.NO.: (If applicable enter "ex mpt' "license license number 1' e.J t . Address: 37 13//�%,/ w6 mr '.via/ve n�, f rng Bus.Tel.No.: J "Per M.G.L. c. 147, s.57-61,secur ty rk requires Department of Public SafetyiS"License: Alt.Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below,I hereby waive this requirement I am the(check one ❑owner ❑owner's a enL + Owner/Agent at PERMIT FEE: Signature Telephone No.