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Home My WebLink AboutBLDE-22-004637 Commonwealth of Official Use Only (? 1! ) Massachusetts Permit No. BLDE-22-004637 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:2/22/2022 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) 34 DRAKE ST Owner or Tenant SWENSON SANDRA L Telephone No. Owner's Address 9329 MAINSAIL DR, BURKE,VA 22015 Is this permit in conjunction with a building permit? Yes ❑ 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: Repair to 0/H service. 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 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. To No.of Alerting Devices 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 Ballasts Data Wiring: Heaters Sims 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 61( '!: % R � DElVED FEB 2 2 202� /'." _�=--_ o saCth o�//(asscu�usafts Official Use Only lil,� �7 —:2!s: It DING DEPARTf�aT c7 n " Permit No. � n .min Jarvrctl 1 ( ' i - - :OARD OF FIRE PREVENTION REGULATIONS----- Occupancy 1/ 7J and Fee blank) >:' .` [Rev. 1/07] `, Q) _ (leave blank) �(/ 4 DQ1 I(‘A TIA►t ran r..�.+...- _,_ :.:: . I I LI SCR ___ C G1 RICA� WORK i \ All work to be performed in accordance with the Massachusetts Electrical Code C),527 12.00 (PLEASE PRINT IN INK OR TYPE AU INFORMATION) Date: \ City or Town of: YAR1VIOUTH `� `� ��ires: To the I ector W By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&Number) $ / or�`/� e-,J „ f Owner or TenantcGi4J � ' t.�I �s Telephone No. Owner's Address Is this permit in conjunction with a ding permit? Yes ❑ Noic:' (Check Appropriate Box) Purpose of Building p,r6,4.) irk,. `�� Utility Authorization No. Existing Service/oO Amps / /)e Volts Overhead ` Undgrd�' ❑ No.of Meters New Service Amps / Volts Overhead �� Undgrd g ❑ No. of Meters r��,., Number of Feeders and Ampacity 4,64:1C X 1 4 , '✓ Location and Nature of Proposed Electrical Work: Completion of the follcrwing 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 SwimmingPool Above In- ❑ 'No.of Emergency Lightmg - :rnd. ❑ arnd. 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 Total . No..of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump 1 Number Tons KW No,of Self-Contained Totals: DetectionlAlerting Devices No.of Dishwashers Space/Area Heating KW -Loral❑ Municipal Connection Other No.of Dryers Heating Appliances , Security Systems:* No.of Water KW No.of Devices or Eq len uivat Heaters No.of Data Wiring: No.of Signs No. No.of Devices or Equivalent ,i No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent '`...i Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of E ectric 1 Work: 3Vd0 (When required by municipal policy.) Work to Start: a f q �2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO E 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 Z.Z. BOND ❑ OTHER ❑ (Specify:) ' I certify, under the p�any perjury,that the inform 'o��is application is true and complete. FIRM NAME: Licensee: U i__. LIC.NO.:�Tc 4 Signature A r j LIC.NO.: l' (If applicable.enter " empt/in ` license rum r li 2�/`/�' J Address: �� Bus.Tel.No.: ��iif �� J Per M.G.L. c. 147,S.57-61,se work requires Department of Public SafetyAlt.Tel.No.: L�Sj ' OWNER'S INSURANCE WAIVER: 1 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/Agental 0 owner's a ent. Signature Telephone No. PERMIT FEE: $