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Home My WebLink AboutBlde-20-000342 0Commonwealth of Official Use Only lt` it Nett Permit No. BLDE-20-000342 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: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 perform thew electrical work described below n , Location(Street&Number) 223 MID-TECH DR /S r1N S(uc c�o_ Owner or Tenant SiblEte2ittililetblISAMIESIC Telephone No. Owner's Address 223 MID TECH DR,WEST YARMOUTH, MA 02673 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 ❑ 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 air handler&condenser. 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 ❑ 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: $80.00 * - Commonwealth oil mamachr.afts • Official Use Only ='iii1 = 1Jepartmanf o/.biro Permit No. arvites ' EGULATIONS BOARD OF FIRE PREVENTION R Occupancy and Fee Checked Y`'�,`• [Rev. 1/07] (leave blank) 0 APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52, CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: `Fi City or Town of: YA�tMOUTH To the I ectolci r of Wires: By this application the undersigned es notice of his or her inte 'on to Derfoixz the electrical work described below. • Location (Street&Number) /�4 J �r Owner or Tenant /J r//� ..�,! S' / r/i �%y �Ct- Telephone No. Owner's Address Is this permit in conjunctiog„with a building t? Yes ❑ No (Check Appropriate Box) Purpose of Building wolf sh Utility Authorization No. Existing Service efp Amps 1,,Lef./5,31,4 Volts Overhead a Und d gr ❑ No.of Meters _ New Service Amps / Volts Overhead E Undgrd ❑ No.of Meters Number of Feeders and Anipacity MA., f 17�-/�j 0/—"1eK ) Location `�nd Nature e,�of Proposed Electrical Work: � /l i e,“/ oeof __ / Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiL-Snsp.(Paddle)Fans No.of Total Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Switnmia Pool Above In.. No.of Emergency Lighting g Arad. grad. Battery Units No. of Receptacle Outlets No.of Oi Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners 'No.of Detection and OInitiating Devices Total _ No.of Ranges No. of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump 1 Number Tons KW No.of Self-Contained Totals:I Detection/Alerting Devices ® No.of Dishwashers Space/Area HeatingKW Municipal L0�❑ Connection ❑ � No.of Dryers Heating Appliances Kw Security Systems:* No.of Water No.of Devices or Equivalent No.of — Heaters KWNo.of Data Wiring: 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 cf desired or as required by the Inspector of Wires. % Estimated Value of ec • 1 Work _57_ , (When required by municipal policy.) Work to Start: /7 I Inspections to be requested in accordance with MEC Rule 10,and upon completion. N 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE le BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury,t t trtforrtpation on this application is true and complete. FIRM NAME: �'eG? ( k� i / �� LIC.NO.c�_ Licensee: VQ x,/ Signature ireI applicable,enterpt"in the license nu be e. 'r it- � LIC.NO.: (f Pp n � f� L_ _ Bus.Tel.No.: ew Address: 22 d3:ltii ' � � 1/'� /�,' LJ /"� j `Per M.G.L. c. 147, s.57-61,s uri work requires Department of Pub Safety"S"License: Alt.L cl.No.. — OWNER'S INSURANCE AIVER: I am aware that the Licensee oa' es not have the liability insurance coverage n — S required by law. By my signature below,I hereby waive this requirement I am the(check one) y Owner/Agent owner ❑owner's t I Signature Telephone No. I PERMIT FEE: $