The URL can be used to link to this page

Home My WebLink AboutBLDE-22-002713 or Commonwealth of Official Use Only /l` , Massachusetts Permit No. BLDE-22-002713 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:11/10/2021 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) 769 ROUTE 28 Owner or Tenant YARMOUTH LODGE 2270 LOYAL ORDR MOOSE INC Telephone No. Owner's Address P 0 BOX 186, 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 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rewire two heaters 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 2 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 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 Siens 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: Licensee: Matthew Gordon Signature LIC.NO.: 55830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:22 Station Avenue,South Yarmouth Ma 02664 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: $80.00 SIA a& 3(i (e(-1, -- eg. RECEIVED > + V 2021 on.monwsak of Mamach eas Official Use Only „ J'sC - .1..--27 I 7.5.:..117...; �[ cc��hpart`nu�o`}c�77 i�+r rv;cse Pcrmit No. '`I i y 'i NG r T Occupancy and Fee Checked 5OA Or FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Codei(1)EC)A227.C 9.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i l 7 J City or Town of: YARMOUTH To the Inspector of fres: By this application the undersigned gives notice of his or her intention to perf the electrical work described below. Location(Street&Number) 7 51 >( ,7dl P o2,L " Owner or Tenant Z'? /' 0 11 Telephone No.6'(7 5 Pt 3,636 Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Boz) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead E Undgrd 0 No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: re IN ;r( -i-w 0 Y l ��4t e✓c �t / Completion of the following table may be waived by the Inspector of Wires. O. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total o' Transformers KVA '-;t No.of Luminaire Outlets No.of Hot Tubs r::\ Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 0 No.of Emergency Lighting grnd. Rrnd. Battery Units No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and „. Initiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers 'Heat Pump Number Tons KW -No.of Self-Contained Totals: Detection/Alertint_Devices No.of Dishwashers Space/Area Heating KW LocalMunicipal 0 Connection ❑ other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs 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: 6 / V 0 (When required by municipal policy.) Work to Start: ///s ly 1 Inspections 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 mollies of p5rjury,that the information on this application is true and complete. FIRM NAME: J41 Lfi VV C� �l(� jam. � y6�r LIC.NO.: .S,� J Licensee:M to) ' b .6a0-,, Signature ---- --.,--'.....--- - ---- —' (/f applicable. . i "exempt",in.the li, nse num>•r lure.) / �� LIC.NO.: Address: _ _ i� _ Y, .�rai!1� . :us.Tel.No.• 6-e *Per M.G. c. 147,s.57-6 ,securi ork requires Department of Public Safety' 'License: Alt.Lic.No. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE:$