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Home My WebLink AboutBlde-22-003708 or Commonwealth of Official Use Only (#ii Massachusetts Permit No. BLDE-22-003708 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:•1/4/2022 City, or Town of: YARMOUTH To te Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work id Locationed.ke Location(Street&Number) 48 PHYLLIS DR GG 1�L l°. 16,U1 Owner or Tenant Fannie Mere Telephone No. Owner's Address 48 PHYLLIS DR,SOUTH YARMOUTH, MA 02664-1680 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 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 ❑ 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 Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tw — 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 Ballasts Data Wiring: Heaters Signs 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 my signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 DILC RECEIVED 111' Co ea[th ell addachudatte Official Use Only ? fl 7 JAN 0 3 20222 c7 s, Permit No. �Z-37 0 ;s+,:� F ar of el' irr •coked I `'' r T Occupancy and Fee Checked '.' ` ' ' I LDB ur rile P.EVENTION REGULATIONS [Rev. 1/07] (leave blank) \\NAPPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12.00 c (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: J jA2 (,...7, City or Town of: YARMOUTH To the Inspector of Wires: 4 By this application the undersigned gives notice of his or her p. tention to dorm the electrical work described below. Location(Street&Number) I g PA /' S V Owner or Tenant � jt/j f !"ie., Telephone No. Owner's Address ---. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) VI Purpose of Building Utility Authorization No. I Existing Service O Amps / /O p /.,2 C�la�VVolts Overhead� Undgrd❑ No.of Meters New Service Amps / Volts Overhead Undgrd El No.of Meters Number of Feeders and Ampacity LA) / _ o _ ,, �L. it 7/ I Location and Nature of Proposed Electrical Work: v"'"` �// u, V) Completion of:hefollowing table may be waived by the Inspector of Wires. - No.of Recessed Luminaires No.of Cell:Sasp.(Paddle)Fans No.of Total `f Transformers KVA 'Z No.of Luminaire Outlets No.of Hot Tubs Generators KVA ,.l 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 'No.of Detection and 1---- Initiating Devices 11 No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW � Connection Municipal ❑ otherother❑ No.of Dryers Heating Appliances Kam, Security Systems:* No.of Water No.of Devices or Equivalent �t0 Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent 4 , No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - No.of Devices or Equivalent OTHER: O Attach additional detail if desired,or as required by the Inspector of Wires. \...) Estimated Value of E tri al Work: (When required by municipal policy.) Work to Start: 3/ Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO 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 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 pedury,that the informs on on this application is true and complete. 0 FIRM NAME:._'O'`'2 �c"x"" LIC.NO.:, 7 4 Licensee: a „__ Signature LIC.NO.:, (If applicable,enter" empt"in the license number line.) 6�� Address: Bus.Tel.No.• c2 a Q /�9r,/*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No. �y - Ste' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. l PERMIT FEE:$ 1