HomeMy WebLinkAboutBLDE-21-001899 Commonwealth of Official Use Only
��` Massachusetts Permit No. BLDE-21-001899
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:10/9/2020
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) 12 GILL AVE
Owner or Tenant LEVINE EMMONS S Telephone No.
Owner's Address 12 GILL LN,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropri:to Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 4/444„,.„ _
New Service Amps Volts Overhead ❑ Undgrd ❑ e. n
Number of Feeders and Ampacity i'
Location and Nature of Proposed Electrical Work: WH boiler replacement 0 �/�
Completion of the following table may be watt' tot Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) No.of
Fans Transformers e�
No.of Luminaire Outlets No.of Hot Tubs Generators K`
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
Initiating Devices Q
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 Siens 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 ❑ OTHER 0 (Specify:)
certify,under the pains my!penalties of,•rjury,that the information on s application is true n�il.cfR�m lete. (�
FIRM NAME: SEASI } GAS 'ACE IINC e C1� W t'7 (' ''
Licensee: Kevin Sai,ii1ders . -'"/ // Signature LIC.NO.: 4 ( t7'/
(If applicable,enter"eiemp1 ri the 1' enses wnmder line.) Bus.Tel.No.: 5087712768
Address 67 H9,IM,nfan Dr, ar out Port675 Alt.Tel.No.: 5084000943
*Per M.G.L.c.'117,s.57-61,security requix{es 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
NV-74 III S(ZcD
Cmuno uosa[th,of Massaclucsolts Official Use On
1 ac� �_ 2tp _[ ire S Permit No.
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and
Fee Checked
• care blank
APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code
(MBC) r• 12.00
(PLEASE PRINT DV INK OR TYPE ALL INFORMA77OJ) Date: /7 r.:'
By this ap City
ioor t own of YARMOU� To the I r of,rr_ : , -���
e[�ersign gives tice 'of his or her on to perform the electrical wo 'd bed below.
. Location(Street&Number) -� T ='� AL/
�� .` Owner or Tenant " / S" t? i.
I r' Tel- honey L'� a 1
I Owner's Address Ski►-t-Z._ NG �.
this permit in conjunctio wilt a 9 G -_=°
1 ( permit. Yes ❑ No 0 (Check Appropriate Bo ��_�
Purpose of Building l� Utility Authorization No
bl'i Existing Service/Q O Amps /�"/ �d Volts Overhead
unasrd❑ ,cress
New Service Amps / Volts Overhead Undgrd 1:�► N N. ,•�, ,kb"
Number of Feeders and Ampacity j�_ iJ Al f— .14, ''.ho , P , ,�.I �1'
Location and Nature of Proposed Work: • �4 aIF
(A) i P- e.— A c� _S a (t-5' tA : L 8 �!
No. ,I?
Completion of the f2 table may ige
q�ed: the if!!
of Recessed Luminaires No.of Cal.-Susp.(Paddle)Fans No.of To A, `�'"
r Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Na of Luminaires S Pool Above in- No.of l!.mergency Lighting
v ,�na. ❑ ❑ > units
No.of Receptacle Outlets No.of Oil Burners
FIRE ALARMS 1No,of Zones
p No.of Switches No.of Gas Burners No.of Detection and
Initiat
ing Devices
�, No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained 1
Totals: Deteetion/AlertinE Devices
No.of Dishwashers Space/Area Heating KW' Local D Municipal
C nnecdon ❑ '
U No.of Dryers Heating Appliances Sego t
No.of Water No.of KW Na of l or ' aleat
V No.of
Heaters Signs Ballasts Data Wiring;
` No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: •
t OTHER No.of Devices or Egniva�ent
Estimated Value of 1 'cal Work /700 t/(When required
nab detaildesired as required by the Inspector of Ferrer.
Work to start: by municipalpolicy.)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
. ii the licensee provides proof of liability insurance including"completed co mp operation"coverage or its substantial equivalent. The
Q CHECK ONE: INSURANCE undersigned certifies that such coverage is in force,and has exhibited
proof of same to the permit issuing office.
BOND ❑ OTHER 0 (S
Q F[RM NAME:the pains and penalties
ySthat the_ iinfporraation on this application is true and complete.
d>J 07eU T i C. G LIC NO.://IS42 rt2
Licensee: '/j, S esi." Signature
(If applicably enter" t••i$ licercee number 1' n) { LIC.NO.:
. Address. 37 4n/ v 1dr7L/ai iv. �Zo�f�r rnl, Bus.TeL No:
j *Per M.G.L.c. 147,s.57-61, Alt Tel.No.:
requires Department of Public Safety�S"License: Lic.No.
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance co
i required by law. By my signature below,I hereby waive this verage n
Owner
wn urge
-ent iwT OCnt i am the(chxk one ❑owner ❑owner's eat.
.Telephone No. . PERMIT FEE: $