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Home My WebLink AboutBlde-19-000538 V 0 ttc Commonwealth of Official Use Only Permit No. BLDE-19-000538 ft` 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:7/26/2018 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) 231 ROUTE 6A O Owner or Tenant HISTORICAL SOCIETY OF OLD YARM Telephone o. A\ W. Owner's Address PO BOX 11,YARMOUTH PORT, MA 02675-0011 `` Is this permit in conjunction with a building permit? Yes 0 No CI (C i - 'a�:'�. rh Pur ose of Building Utility Authorization No. P `( Existing Service Amps Volts Overhead 0 Undgrd 0 No. 6 v, _ New Service Amps Volts Overhead 0 Undgrd 0 No.of Me Q W C Number of Feeders and Ampacity 1 .� Location and Nature of Proposed Electrical Work: Replacement HVA• „* '' :' I Completion of the following table may be waived by the In . W or 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 Initiatinc 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 perjuiy,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:$260.00 „,i):,,,,_ - _ ,1- ��prr..��rt o15i.�Serrf s Permit No : , BOARD OF FIRE PREVENTION REGULA T IONS Occs�aacy and Fee Checked _- lReti. 1/D7] (]ezve blank) APPLICATION FOR=PERMET TO PERFORM ELECTRICAL WORK Al work to be performed in accor cc'xito me Massachusetts Electrical Cods WE ,527 Cl . 12.a0 r-7 4< . (P j E PRMIT N 11\-OR %lPE AL DVFOR,LITIOh9 Date- �, City or Town of: YARMOUTH To the Inspector nspector o Fares: By this application the Indersigoed s notice of his or her intention torperfo=i the electrical work:described below. Location (St-eet&Number) 23 / -,r/f ier7��J &-, ' �� Owner.orTenant 0 Pe'r� r Telephone No. 0 i Owner's Address ./t �ft-- p� permitIs this ill conjunction with a butt ' a , Yes _ No ❑ (Check Appropriate 1301) Purpose of Buldhaz eQs1 (-se Utliiy.AntIoorrsa�on No. Rrra Serviceraor Amps // [ /mac Volt Overhead / � IIn4td❑ No. of Mews New Service Amps / Vohs Overhead Cndgrd ❑ N . of MetersNufabs of Feeders and rapacity ,i`! 'd �ales�'r 1 Location and Nature of Proposed H antrical Wor _ Cozapt- n of the forlowizzg table be waved by the Inspector or Firer. rr_r. No. of Recessed L*r-,;,,oiles No. of Ce1Z-Srasg.(Paddle)Fans No.of Total Transformers gYA No. of Lammzf-e Otr-det No. of Het Tubs Generator; KVA • No. of Luminaires _y Pool Above ❑ in- ❑ _ n.of�m��cp .�m� 5�rnmrs.c end. urns P. i±.t t IItria * - No. of Receptacle Outt=; No. of Oil Etrl-ners ( ,-� fF'fz;�ALARMS Na.of Zones No. of Switches INo. of G`s Bcu,zers No-of Don _ f- rrr;ri9 u D andevices No.of Rases No_of Air Cond. Total Tons :No.ofereae Devices No.of Walt*DisposersHeat Pump amber Tons I KW o,of etf-Cont%Trr. Totals: I ((N I lDti._uonJAler anz.Devices No.of Dishwashers • ISpace./Arta Heating KW' Local Q Mttaicipal CQanection 0 Crater No.of Dryers Heating A n Appliances KW Security Systems:* ( No. of Water No.of Devices or Equivalent �J Heaters KW No. of No. of (Data Wiring: U Si= Ballast No.of Devices or Equivalent �� No.Hydro aassage Bathtubs No. of Motors Total HP Telecommunications Wiring;v No.of Devices or N OTHER Equip alert _ Aiii- _Attach oddi.tionol detail tf desired or as required by the Inspector of*Tires. Estimated Value of Electrical Work CIS; (When required by municipal oli k Work to Start: P cY�) Inspections to be requested in accordance with MEC Rule I0,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, T1e -1 undersigned certifies thRt such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: NSURANCE?fc, BOND 0 OTHER 0 (Specie:) I cersfy, ander the pairs and eriziol s of pelf that e information on this application is true and complete. A FIRM NAME: 4 G LIC.NO.-AL Licensee t _ 0- Signature LIC.N of applicable, eater !'in the license r Address nf• pJ ' Per ess: c, 147, s.o7-bI,S ' i OWNER'S erM INSURANCE , ty ork requires Department of P4)44'7Itf ic Safety"S"License: Lit.No. " • law. WAIVER: I am aware that the Licensee does nor have the liability insurance coverage normally requit byBy my sigrmtnre below,I hereby waive dais requirement I am the(check one)❑ owner 0 owner's a eat i O4eaer/Agent 1. l Sign at¢r a Telephone No. PERMII FEE: $