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Home My WebLink AboutBLDE-20-000622 Commonwealth of - Official Use Only €. Massachusetts Permit No. BLDE-20-000622 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:8/2/2019 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) 89 SHAKER HOUSE RD Owner or Tenant KOPEC CHRISTINE Telephone No. Owner's Address KOPEC CATHERINE MARY,423 HARTSHORN DR,SHORT`HILLS, NJ 07078 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 furnace. 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 CIIn- ❑ 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 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/Alerting 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 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 c (2d Q Cornwnwii€s fc of 22712.331.71.4.10.114 ,. • Official Use Only imi= 2epa> o f .Serviee5 Permit No. °,jC�E -a� -oo��-� = [R BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev. 1/07] cleave blank) APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code WORK VOIL (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 527 CMR t 2.00 cityor Town of: ) ��II q YARIVIOUTH To the Inspector o Wires: By this application the undersigned gives notice of his or h int lion to perform the electrical work described below. Location (Street&Number) Qi . a 2 s, c Owner or Tenant c ;-1 5'1 'i, e ,k",f€ G °lei( Telephone No. Owner's Address 97: ta3 Is this permit in conjunction th a b t./'n ermit? Yes ❑ N9/g) (Check Appropriate Box) rpose of Building % ,}' 0 ,� W �� Utility Authorization No. w N� 'sting Servic, ` Amps ,j /DJ/ Volts Overhead F2. Undgrd❑ No.of Meters ' tr w Service �- Q Amps I Volts Overhead❑ Undgrd ❑ NO,of Meters "� c IN tuber of Feeders and Ampacity (, )/ P w l J Doc, lion and Nature of Proposed Electrical Work: t� �S Z GJ let: —:uC swrk w. V< n J_ Completion of the follawin&table may be waived by the Inspector o 1 res. i tt, .of Recessed Luminaires No.of CeiL-S (Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.Hof Hot Tubs Generators KVA �� No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of l";mergency Lighting V _ erred arnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones pNo.of Switches No. No,of Detection and of Gas Burners Initiative Devices No.of Ranges No_ of Air Cored Total . � Tons No.of Alerting Devices _ No.of Waste Disposers Heat Pump I Number I Tons KW No,of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal _ Connection ❑ Other `,U No.of Dryers Heating Appliances KW Security Systems:* No.of Water No. of No.of Devices or Equivalent Heaters KWNo. of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Elec 'cal Work / Attach additional detail f desir ed or as required by the Inspector of Wires. (When required by municipal policy.) N. Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C RAGE: 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 O undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. Q CHECK ONE: INSURANCE., BOND ❑ OTHER ❑ (Specify:) ct I certify, under the pains andpenalties o ) fperjury,that the information on this application is true and complete .A FIRM NAME: O '-___Co d—r 0l eet i:-4J� LIC.NO,: 4u ro Licensee: -i S r# / Signature (If applicable,enter"es mpt""license.license number 1' e.) LIC.NO.: Address: 37 ,i/ !',„7 f 7�iii l'J1 7 , ".J. �, Bus.Tel.No.: J Per M.G.L. c. 147,s.57-61,securt rk requires Department of Public Safety4"License: Alt Lic.NoTel. . — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance cover nonoagermally S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner Owner/Agent ❑owner's a era. ,I Signature • Telephone No. .• PERMIT FEE: $