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Home My WebLink AboutBLDE-20-000194 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000194 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:7/12/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 69 CHERRY LN Owner or Tenant MANCUSO ANTONIO Telephone No. Owner's Address 78 MARKHAM ST, MIDDLETOWN, CT 06457 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring for NC 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 ❑ In- ❑ No.of Emergency Lighting rnd. 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 ❑ 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 et 1 4.76( (Pgl* g • (roncmon.wea&of Madsaciucalfs • Official Use Only _ el = 1JaParfinaaE or-ire Serviced Permit No. �" / o t ' Occupancy and Fee Checked "- BOARD OF FIRE PREVENTION REGULATIONS 1-Rev. 1/07] ---- (leave blank) 10, r1) APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK V All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / // 19 City or Town of: YARMOUTH To the Inspe for o Wires: By this application the Emdersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) cr �e,tit,ft, ,c\V t 2�f •1 41 Owner or Tenant �� Al S' a Telephone No. ��0 Owner's Address 77� , / Is this permit in conjunctio with a b 'ding permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building �A/-J' Utility Authorization No. Existing Servioy'f® Amps`4-73 ‘320( Volts Overhead Undgrd i ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd g E No.of Meters Number of Feeders and Ampacity Lid f ` 0 p 1.,LI . _ t /q� Location and Nature of Proposed Electrical Work: O 4-J �r ` Gold__ Completion of the following table may be waived by the Inspector of Wirer. l '' No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total S Transformers KVA 3 Y No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting - grad grnd. � Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices 1 • No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:l { Detection/AlertingDovices No.of Dishwashers Space/Area Heating KW' t.Local Q Municipal - Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KWNo, of Data Wiring: Signs Ballasts No.of Devices or Equivalent 1. No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - No.of Devices or Equivalent v OTHER: ,......------Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El tri 1 Work: -SO0.- (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. Li INSURANCE C 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 CI 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 penalties of petiury,that the formation on this application is true and complete. FIRM NAME: OFF-sly' G/✓� LIC.NO.:/7/ li Licensee: iU ef1 2 J. Signature s LIC.NO.: (If applicable,enter "ex pt"in tie license number l' e.) . Address: 3"7 c; � Qn w` Bus.Tel.No.: J Per M.G.L. c. 147,s.57-61,sec k requiresAlt.Tel.No.: h'w Department of Public Safety" "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)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $