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Home My WebLink AboutBlde-20-001365 or Commonwealth of Official Use Only Permit No. BLDE-20-001365 to Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 1Rev.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 Inspec r of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described b to . Location(Street&Number) 176F WINSLOW GRAY RD - -7-ifil NJ/} kt ON 0 Owner or Tenant Telephone No. Owner's Address UTH YARMOUTH, MA 02664 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: Replacement HVAC. 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 1 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 ❑ 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 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 Commonwealth of//la4sac ffs ,- • Official Use Only nnly f• c'� Permit No. �� l 6� ..Uepartnanf pig-ire Serviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ,[Rev. I/07) (leave blank) --- APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK delij All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 l2.pp AA) (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g' /6 i 7 By �/ l [I City or Town of: YARMOUTH To the Inspec or of Tres_ I (1 this application the lmdersigned gives notice of his or her intention to perform the electrical work described below. - i Location (Street&Number) . �� • ,der or Tenant a S " JA , i I 0 0 A)a Telephone No. 4' '--- - -,,9wpier's Address � v ,-.. �,�IJ ,e,<,,,,w f 14,1 ,-• is tiiis permit in conjunction 'th a b ' 'rig permit? /Yes ❑ No ;�C; f- i ❑ (Check Appropriate Box) (.4 (v '9Puttpose of Building .A.A) Utility Authorization No. O ,E sting Service/0 0 Amps / a%0 Volts Overhea Undgrd❑ No.of Meters a, c:L ` Veiry Service Amps / Volts Overhead �'Ndl,. D Undgrd ❑ No,of Meters mber of Feeders and Ampacity Location and Nature of Propos d Electrical Work: ' e- �� - �'► A ' Al " .� ae� . , ..r / i •" i"ram Co •letion o the ollowin- table m• be waived•�for. o Wires. No.of Recessed Luminaires No.of CeiL-Busy.(Paddle)Fans o.of Total Transformers 1{VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.' of Emergency Lighting t:rnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones �p No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total t- No.of Ranges No.of Air Cond. Tons ,No.of Alerting Devices 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❑ Municipal Connection ❑ Other 2 No.of Dryers Heating Appliances KW Security Systems:* No.of Water No. of No.of Devices or Equivalent V Heaters KWNo. of Data Wiring: Signs Ballasts No.of Devices or Equivalent <` No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: # )A, OTHER: No.of Devices or Equivalent (1� Attach additional detail if desired or as required by the Inspector of Wires. � Estimated Value of E ec 'cal Work (When required by municipal policy.) Work to Start: rp / Inspe 'ons to be requested in accordance with MEC Rule 10,and upon completion. O INSURANCE C VE E: Unless waived by the owner,no permit for the perfo rmance 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: INSURANCE, BOND 0 OTHER 0 (Specify:)� I certify, under the pains and penalties ofperjury,that the information on this application is true and complete. 0 FIRM NAME: �O R4o0,1't-s-tuts 0leC r it C. ,cJ� LIC.NO.: 0270 Licensee: _ '/t y �S rl/ Signature (If applicable. enter "ex mot" t license number 1' e.J t LIC.NO.: . Address: /per vr6 f '.Via/ve n , �r rn-, Bus.Tel.No.: j `Per M.G.L. c. 147,s.57-61,fSecu y rk requires Department of Public Safety�S"License: Alt.L c.No. ,— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�ly S required by law. By my signature below,I hereby waive this requirement I am the(check one 0 owner ❑o r' Owner/Agent • Signature Telephone No. PERMIT FEE: $