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Home My WebLink AboutBlde-19-006982 or tt, ./0 Commonwealth of Official Use Only ifi Massachusetts Permit No. BLDE-19-006982 lt111 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] 1 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:6/11/2019 City or Town of: YARMOUTH To the Inspector of Wires: cve 7 75'' '` 1 By this application the undersigned gives notice of his or her intention to pe the electrical work ribed below. i�,(� Location(Street&Number) 53 CROMWELL DR pE O ei-e-1_0IJ As Owner or Tenant TRS(LIFE EST) Telephone No. Owner's Address BA S(LIFE EST), 17 JUNIPERWOOD DR, HAVERHILL, MA 01832 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 A/C 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 0 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 Initiatinu 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 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 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:$50.00 ;., s _= Commonmsatth o///laach:cssLts • Official Use Only 11- 112eparfmsnt el.7irs._Service Permit No. Q 4 fb?----- 1'— ' Occupancy and Fee Checked 'R.r �7 BOARD OF FIRE PREVENTION REGULATIONS rRev. 1/07] z_t � _ (leave blank) • APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: (ME .527 q 12.110 City or Town of: YARMOUTH 7 �ir By this application the dersi ed To the the electrical cto of Wires: im gn gives notice o his or her' tion to perform work descnbelow Location (Street&Number) �.3 �✓� t --- gob g Owner or Tenant �a �' ee u q F /`f Owner's Address Sic-,r� Is this permit in conjunctioq,with . b Telephone N � mot'' iiug Permit? Yes [� � ` ❑ Nu (Check Appropriate Box) C/ _ Purpose of Building , Utility Authorization No. Existing Service/60 Amps 94 / VI Volts Overhead Und d gr ❑ No.of Meters New Service Amps / Volts Overhead❑ Undg rd ❑ No.of Meters Number of Feeders and Ampacity -s S , Location and Nature of Proposed Electrical Work:( _ /TO� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cei1.-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- 0 No.oI 1~mergency t,ighang - t:rnd trod. Batter7 Units No.of Receptacle Outlets No.of Ott Burners FIRE ALARMS INo.of Zones 4 No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No,of Alerting Devices - i No.of Waste Disposers Heat Pump[Number I Tons I KW No,of Setf-Contained Totals: Deteetion/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Omer No.of Dryers Heating Appliances KVV Security Systems:* No.of Water No.of Devices or Equivalent of No. No.of Data Wiring: Heaters KW L Signs Ballasts _ No.of Devices or Equivalent - t No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or OTHER: Equivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work (When required by manic al oli Work to Start: � p �') Inspections 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 NI the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The i` undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER El (Specify:) f certify, under the pains and penalties of perrijury,that the in o�rm 'on on this application is true and complete. b FIRM NAME: c c a 0,- ,`'2� E-"' 2 L0L-9'4 .'% LIC.NO.: Licensee: p Signature LIC.NO.: �'�/ (If applicable,enter �sem t to a license rtu . Address: '?7 fcr`0j✓� erlip� �/ .f„IJ Bus.Tel.No.: � J *`Per M.G.L. c. 147,s.57-61,s uri work requires Department of PublierSafe Alt.TeL No.: OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage n— o ly required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner Owner/Agent ❑owner's a ISignatureD Telephone No. PERMIT FEE: $