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Home My WebLink AboutBlde-20-001929 Commonwealth of OfficNft ial Use Only Massachusetts Permit No. BLDE-20-001929 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:10/8/2019 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) 105 NANTUCKET AVE Owner or Tenant ROBILLARD EDWARD W JR Telephone No. Owner's Address 3 CARDINAL CIR, LONDONDERRY, NH 03053 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: Replacement boiler. 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. grnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 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/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 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 t k 1 � rc 10l r RECEIVED `/ . _ ..__ Commonweattt/� ��jj of//laddacho-dstts :: Official Use Only OCT 0: ''' ��_-, cc�'� a �i= _ 2 ��77i2.4 epartmeni oil re ServicedPermit No. BUILDING D E P ,• ' Occupancy and Fee Checked :,y BOARD OF FIRE PREVENTION REGULATIONS [Rev. Uri (leave blank) • APPLICATION FOR=PERMIT TO PERFORM ' \ All work to be performed in accordance with the Massachusetts Electrical CodeodELECTRICAL WORK V (ME(M ,5 CMR ]2.D0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: f D F f 1 Aorr MCity or Town of: YAROUTH To the Inspector of Wires_ By this application the undersigned gives notice of his or her i tention to perform the electrical work described below. Location (Street&Number) / s ct A f� e/k / q Owner or Tenant .� ; 1' ��1 l Telephone No. Owner's Address Is this permit in conjunctio with a o ilding permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building (/-1---- Utility Authorization No. Existing Service ,a Amps / 4 /a..Cid Volts Overhead '12.11P Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Pro osed Ele 'cal Work: IA 1 p 2 Qj ) l e4 RC If/L- te 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 Swimmia ool Above In- ❑ 'No.of It mergency Lighting v g p arid. Elgrnd. 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 •Total . Initiating Devices Z No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating ICW Municipal Low❑Connection ❑ Otfier . No.of Dryers Heating Appliances KW Security Systems:* ` No.of Water No. ofNo.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent .C. No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent n' OTHER: .� Attach additional detail if desired or as required by the Inspector of Wires.Estimated Value of Ele trio I Work: yqc- (When required by municipal policy.) Work to Start: le) /V/ q7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. O INSURANCE CO 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. (l CHECK ONE: INSURANCE,, BOND 0 OTHER 0 (Specify:) QC I certify, under the pains and penalties of perjury,thatat the information on this application is true and complete .A FIRM NAME: O O *—.5-&.1"0leCer I tioUC--- LIC.NO.: 4 .2 n? Licensee: '/j• 4 ri" SignaureLIC.NO.:"36(If applicable,enter "es mpt"irp O license number l' e.) O _/S 9 Bus.Tel.No.: Address: 37 �, ,7 r ��/ Ie O" Alt.Tel.No.: __ :0_ ,.. 77 J Per M.G.L. c. 147, s.57-61,securf w6rk requires Department of Public SafetyiS"License: Lic.No. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage nor m lly 5 required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent Owner/Agent Signature Telephone No. I PERMIT FEE: $ �j(� I