HomeMy WebLinkAboutBLDE-21-007590 Commonwealth of Official Use Only
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Massachusetts Permit No. BLDE-21-007590
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
LRev.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:6/29/2021
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 etectncal work described below.
Location(Street&Number) 105 BEACON ST
Owner or Tenant BERQUIST NANCY E Telephone No.
Owner's Address 105 BEACON ST, SOUTH YARMOUTH, MA 02664
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 ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Check previous work done by others(BLDE-17-004429)
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
Inrtiatine 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/Alertinc 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 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: $75.00
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BOARD OF FIRE PREVENTION REGULATIONSOccupancy
-�Fee Checked
(A) 1 / APPLICATION FOR PERMIT TO PERFORM
An"°` iO be iaccordance n rba iCoda EELECTRICAL WORK
(PIF.��E'PRDy „ � 527/.. 12.00
Ila.OR TYPE ALL ORbuT1O19 Date:
�y or Town at -• � i � -
By ti:is application the notice
To the InspeCtoT
• ./ Location( ofhrs ocher P I ' Wires: .
) .s 4 described below.
Tit /1 et/LIC �� V .5; /L
d ? , 'Owner's Address Telephone No.
Lsthis permit inw ,1,
.r, ,�
P ' Yes 0
No 0 (Cheek A
Appropriate Box)
Purpose at dill,
UtyA No.ExbdotE Service�� Amps f--- Volts Overhead •/ p�❑ No.of Meters Nev / Vohs
if
Uadtt d❑ Na of Meters
Nuin( -of Feeders and Am�padtj
,-4�/' ' Milan of Proposed BJxriid Woric /'.��L l` '
i w_ _ //
41.
of Recessed a No.of Ce�Sasp,(Paddle)Pam �
o,of Luminaire Outlets Tis KYA
M a.ofLw.es Solinambog Pool , ❑ i�vw
-O Outlets - a.of OB Banners FSS IIa&s
No.of:::RangNo-of Gras Burgess _ - - ► s, ,
Alr
No.of Waste Disposers ;r--� ,C ....., Tons a 0.ofA1a�S Devices
No.ofd
Dishwashers
Totals: 1ons 111 a ws-;,.,
Spam/Area H �"��Anneey �,,
Ueating KW- Locala Devices
, _.,,
0.of Dryers 0 O�
Heating
'o.o "ater
KW
No.of
or
_X/ Heaters -KW `o.o .Q o ._
I to J't _
No.Hydromassage Bathtubs
Ballasts
o.of Motors Total HP ^'^oilDevices or ' 1 aught
OTHER1 1 nous i; I '
■is�yja� _ Na of Devices _1 ., _
Estimated Value of E •, adorrat ..
Wow o rs oras
"� Work b Stagy /, 2/ ection5 b (gym regnited by
a policy.)'erdred�the Inspaera,•of Wires. :
O INSURANCE MEC
licensee ,Proof()Mobilityunless by the owner,no
Pmt for the Role 10,and apon mon.
Q o thatunflersigned certifies "completedhas • �a electrical amorannal" e mayuissueunless
isan ° erae as
qng°ffice.
IEC ander E �AT BOND 0 OTHER Prvofofsaime b die Permit s The
O IFIRMcero NAME, Pai+rsord ,PenaldesofPer saZ that the Ojos en app orris
I leensec _ del-f' r• tragi acrd ao°O `,�
(fh t e -. . . - �4'-= '`� S % GEC NO.: /3 0
J 'Per M.G.t„ 147,s.sr-61 .._Address: 4; i -y '` 4ilt/t!- 0, - O"i1- rn— Baa.Tel.N .
Q OWNER'S INSURANCE w w , . 1equi Department of Public . _ Art.TeL
N 14 yop
-
latw• BY ray si 1'roaware that the Le� j. tioaraee does na have I. Ninsumaceo, _
d Sirequired bY a 7z4�t. tam the(�tine wne °°crav(Y
°a'ac orvaer's a
.Te7ep6oneNa PRRIr.�rr warp. . �i��---...
RECEIVED
JUN 28 2021
BUILDING DEPARTMENT
By: _
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