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HomeMy WebLinkAboutBlde-19-001103 7 Commonwealth of Official Use Only 41141411-7 Massachusetts Permit No. BLDE-19-001103 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:8/22/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 137 SEAVIEW AVE A 'Owner or Tenant RAGO NICHOLAS F III Telepho. . o. Owner's Address RAGO CAROL R, 108 NICOLE DR,SO GLASTONBURY,CT 06073 �� Is this permit in conjunction with a building permit? Yes 0 No 0 ( . •• o e ,! Purpose of Building Utility Authorization No. O Existing Service Amps Volts Overhead 0 Undgrd 0 No. f M • t/I Amps Volts Overhead 0 Undgrd New Service 0 No.of Mete.. APN6 Iv Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wire bathroom,paddle fan,exhaust fan,vanity light,receptacle, re_ces_sed • washer/dryer&exterior flood lights. 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. grad. 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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: $75.00 2 ,0cH E(2)4,8 C.ommorsrucattfs o /�j ` ice ► .= fi e(a3aacfu�a!f� O/l�e O Y —_Vi-- t� c7 n -=- I= i 2cparlanrnt o/-}ir�a J Permit No. C 0� .3) ‘ ‘ - crvicc3 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked i, (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 C 12.D0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: G) City or Town of: YARMOUTH To the Insp ctor of ires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. • Location (Street&Number) ��e�� y D/ Owner'or Tenant Al/C.�\ O O Telephone No. 2 Owner's Address Is this permit in conjunction h a boil ' g permit? Yes No - % �� f/ `. (Check Appropriate Box) (N Purpose of Building � Utility Authorization No. 4/ Existing Amps Servic 06 C l01</ �f9 Volts Overhead F? Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No, of Meters ('� t-- Number of Feeders and Ampacity 4)/p _ 9 )ems J4 CID Location and Nat'11; 1?„124-in ,,` /-e-- tdzivXert--q'v-eYece> R, 1, _ ___ tuure of Proposed Electrical Work: �/QIe/, �d V >0) UJ aticr-colalea4_:fik � � s w Completion of the following table may be waived by the rtspector of Wires. W E Q No. of Recessed Luminaires No.of Cei1 Susp.(Paddle)Faris No.of Total (,� , l Transformers KVA v c 1 z No. of Luminaire Outlets No.of Hot Tubs l Generators K'VA W < o ' �' No. of Luminaires Above Ia- No.of L.mer en Lighting 1 (m© Swimming Pool ,�� ❑ ,rnd. ❑ IBattery units of Receptacle Outlets No.of Oil Burners 1FIRE ALARMS No.of Zones No. of Switches INo.of Gas Burners No.of Detection and Initiating Devices No. of Ranges }No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Hest Pump Dumber 'Toss KW No,of Self-Contained Totals: I I_ IDetection/AIertino Devices No. of Dishwashers Space/Area Heating KW• Loci.[ Municipal D Connections No.of Dryers Heating Appliances KW Security Systems:* No. of Water No.of Devices or Equivalent No.of Heaters ' No. of Data Wiring: Sims 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 ec ' al Works (When required by municipal policy.) Work to Start: �, /r Inspections to be requested in accordance with MEC Rule l0,and upon completion. INSURANCE OVE GE: 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 ►,'BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and.en ' s of perjury, that the iinformation on this application is true and complete: FIRM NAME:_�p" e/'/s'„-h9e `1c LIC.NO.: A5a90 Licensee: �q �p/ j/ Signature LIC.N0.• 6Q( (If applicable, enter " em t f ' the license ber line.),, �1 Address: G�/7 g�r��ve IDee/M.S Al Bus.Tel.No.: j Per M.G.L. c. 147, s.57-61, ec work requires // Alt.Tel.No. ty Department of PubliceSafety"S"License: 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 0 owner's agent. Owner/Agent tlI Signature Telephone No. l PERMIT FEE: $ '15'✓