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HomeMy WebLinkAboutE-20-341 Commonwealth of Official Use Only ifE t1S Massachusetts Permit No. BLDE-20-000341 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 noIice of his or her intention to perform the electrical work described below. Location(Street&Number) 32 OLD CHURCH ST C“ (CAD ` 74.c? Owner or Tenant Telephone No. Owner's Address • ' - "' — ---,YARMOUTH PORT, MA 02675 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: Split NC system. 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. Batter'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/Alertinc 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 ( ((ct 6 q (( 3 (,c r w * - • Commonwealth o f ma65aciu wits -• Official Use Only gf�= 1Jepartmmnt o f,fire Services Permit No. t......_, BOARD OF FIRE PREVENTION REGULATIONS Occupancyv. 1/07] and Fee Checked 0,`f / (leave blank) - /"f APPLICATION FOR°"PERMIT TO PERFORM ELECTRICAL WORK , ,r IA All work to be performed in accordance with the Massachusetts Electrical Code C),52. CMR 12.00 U`i I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 6 7 /P Cityor Town wn of: YARMOUTH To the ector ofWires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. pv__ Location (Street&Number) 'IF / Owner or Tenant ��j ��" pq �/ Telephone No. Owner's Address --z -z ©/� 4A 4 0/ Is this permit in conjunction th a bu" ing permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building / Utility Authorization No. Existing Senice/Q 0 Amps b? ,QVolts Overhead Undgrd❑ No.of Meters / New Service Amps / Volts Overhead❑ Undgrd gr ❑ ENO.of Meters ` � Number of Feeders and Ampacity u� , 7 j,� fJ j 7 e �"j Location and Nature of Proposed Electrical W r c: ,Q.�^, ,/ m,,"-.)r/�V '� W 1 12P 1,�d' " .ti i J li �lL� /S Completion of the followirvable 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 Aboved ❑ In- 1-7 No.of le mergency Lighting rttd. Battery_Units No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS [No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump j Number I Tons I KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW• Municipal Local 0 Connection 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KWNo.of Data Wiring: - Signs4 ,:‘ Ballasts No.of Devices or Equivalent ti: 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 E ectric l Work6,74s,- (When required by municipal policy.) Work to Start: !7 J7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C YE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless tl 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 F BOND ❑ OTHER 0 (Specify:) K I certify, under the pains and penalties of perjury,th the i ormation on this application is true and complete. FIRM NAME: LeGy}J-5'e•/fP l LIC.NO.: � 94 Licensee: COI�dl� Signature __ (If applicable.enter "ex LIC.NO.:" �� / pt"i the license nu ben `�-,.-- Address. r .�41e.- ) 'j"p'/ Ate. Bus.Tel.No.: J` "Per M.G.L. c. 147,s.57-61, uri work requires Dep en of f Public Safes`"S"License: Alt.Tel.No - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Lin.No. 5� insurance coverage nortn�ally-" required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner ❑owner's a ent. Owner/Agent lI Signature. Telephone No. . PERMIT FEE: $