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Home My WebLink AboutBLDE-22-005248 0AM Commonwealth ofOfficial Use Only MassachusettsPermit No. BLDE-22-005248 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:3/21/2022 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) 53 WILSON RD Owner or Tenant DUGAN TIMOTHY E Telephone No. Owner's Address DUGAN MARY K,9 THE PADDOCK LAND, MEDFIELD, MA 02052 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices 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 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 ❑ (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:$50.00 e ot( c).(.0 R . gypRe-rfb4 r MAR 17 '022 ,f64 Commmvaai o`///amacliamdieOfficial use Only BUILDING �.tF Lim. 1;' _ c7� c7fi L Y — .1 partnsenl el.�`ir e Serviced Permit No. l✓ �� '11-- l ' BOARD OF FIRE PREVENTION REGULATIONS1/07]Occupancy and Fee Checked [Rev. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 1 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: f 7 / Z, 3- City or Town of: YARMOUTH To the Inspector of Wires: 3y this application the undersigned gives notice o his or her intentio, to perform the electrical work described below, Location(Street&Number) f 3 Owner or Tenant Owner's Address Telephone No. ' O o 2, Is this permit In conjunction with a building permit? Yes Purpose of Building____________0 NO� (Check Appropriate Box) Utility Authorization No. Misting Service Amps / Volts Overhead❑ Undgrd Nom,Service 0 No.of Meters _ Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: re •c be � m � - /, ',A►iom• the ollowi : table m, be waived b the/ No.of Recessed Luminaires No.of Cell.-Soap.(Paddle)Fans Transformers VA o Wires. :,t No.of Luminaire Outlets No.of Hot Tubs A `" Generators KVA A' No.of Luminaires Swimming Pool de o u- 'o.o 'Units intricacy ;ng ' No.of Receptacle Outlets �d. ❑ Butte Units ., No.of Oil Burners FIRE ALARMS No.of Zones c No.of Switches No.of Gas.Burners `a o t^ec, ,n an, 11 r leo.of Ranges Initiatin Devices No.of Air Cond. °' No.of Alerting o.of Waste Tons Devices N Totals: um, r ops _ .:...:�... 'o.o on't n L No.of Dishwashers Space/Area Heating KW Local •(Inn No .of Dryers Heating Appliances CyonnecHoa ❑ Other KW °'o '' r KW o.o,o No. f Devices or ' ,uivalent Heater o Data Wiring: Np.Hydro a Bathtubs S S. ,s Ballasts No.of Devices or ',uivalent OTHER:Hydromassage No.of Motors Total HP �O� or : gg No.of uiva7ent Attach additional detail If desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: 3 !4 Z (When required by municipal policy.) Inspec ions 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"co mpleted undersigned certifies that such coverage is in force,and has exhibitedproof fsame to the or its substantial equivalent. The CHECK ONE: INSURANCE,. BONDpermit issuing office. I certify,under the pains an-penalties o 0 OTHER 0 (Specify:) FIRM NAME: Pr1 lP0('k�J that the lnjorerratlop on this application is true and complete Licensee: fi✓� '�p W ► Signature LIC.NO.: $ (If applicable.enter"exempt"in the license number linea LIC.NO.: Address: Bus.TeL No.: 6'07 *Per M.G.L.c. 147,s.57-61,security work requires Decafety Alt.TeL No.: 7 OWNER'S INSURANCE WAIVER: I am aware that the Licensee not have the liability insurance coverage normally required by law. By my signature below,I herebyIN this requirement, I am the(check one owner Owner/Agent • owner's a:ent. Signature Telephone No.