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Home My WebLink AboutBlde-20-002934 Commonwealth of Official Use Only XE.. Massachusetts Permit No. BLDE-20-002934 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:11/19/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) WILLOW ST Owner or Tenant YARM CAMP GROUND ASSOC INC Telephone No. Owner's Address C/O LEE W ERICKSON,455 QUINAPDXET ST,JEFFERSON, MA 01522-1461 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 Loca •• • and Nature of Proposed Electrical Work: Receptacle for water heater. Replacement furnac 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 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 No.of Gas Burners 1 No.of Detection and Initiatine 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 ❑ 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 Sins 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 ❑ 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 tt (Zok 1 ' ife Commonwealth of Mamac lfl >_ • Official Use Only '- _�_ , fps 2e' $ 3� {_' Apartment Permit No. _=iml-_ 5 Apartment o ervicee =t=i •=• Occupancy and Fee Checked 'f-,., .� BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07) (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK 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: /� �9 /7 City or Town of: YARMOUTH To the I ctor o By this application the undersigned gives notice of his o her int 'on to perform the electrical ork described below. Location (Street&Number) fi / / - '%e Ow er or Tenant Te one No. / ® er's Address � ,f Cr, is permit in conjunction with a Wilding permit? Yes No �. l ❑ Check Appropriate Box) ' N cu 'ose of Building 1�/ Utility Authorization No. � •,� .rig Service o Amps / r� LU d F �r=''" /, ' Volts Overhead Undgrd❑ No.of Meters e Service Amps / Volts Overhead /, ❑ Undgr-- N%of Meters U.:, ,A‘? -Ntt ,ber of Feeders and Ampacity ,� .�.. _a.�' .�� —,: , - L. :L. ...___i o lion and Na e of Proposed Electrical Work: ' 4 Af �, , f� Ce� 1 Completion of the follawing_table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of CeiL-Sttsp.(Paddle)Fans No.of Total Transformers I{VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rnd rrnd. Battery Units No.of Receptacle Outlets No.of On Burners FIRE ALARMS 1No.of Zones �p 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 No.of Waste Disposers Heat Pump 1 Number I Tons I KW No.of Self-Contained Totals:I Detecuon/Aierting Devices No.of Dishwashers Space/Area Heating KW' Municipal Low❑ Connection 0 Other `,U No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent v Heaters ' No.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 Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of El ctric I Work (When required by municipal policy.) N. Work to Start: /S' / Inspections to be requested in accordance with MEC Rule 10,and upon completion. O INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless Al Al 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 0 OTHER 0 (Specify:) cx I certify, under the pains and penalties of perjury,that the information on this application is true and complete .A FIRM NAME: O O `d�.So/4Z Oleafr t L /cI LIC.NO.: /7/5�70 Licensee: -IL S rs-/ Signature 's` LIC.NO.: (If applicable, enter"ex rapt"irk t license number lie.) Address: 37 ,��'fie,f7�-it/t n f Mei Bus.TTel.No.: yam{,5 .j 'Per M.G.L. C. 147,s.57-61,sec rk requires Department of Public SafetyiS"License: Alt.Lic.No. !// -- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n� 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 1.11 Signature Telephone No. [PERMIT FEE: $ I