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Home My WebLink AboutBLDE-22-005246 :'''''`� Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-005246 141 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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 descr ed below. /� Location(Street&Number) 46 PINE ST (p(03� S76--353 Owner or Tenant SLOVENKAI MA j)trid Telephone No. Owner's Address 46 PINE ST,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. t 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 lv`k 10-cl- 66, c-7577 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 Initiative Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: Nq.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: $50.00 �I7.04Sri( ti-dil. q(z,( 04. l o o(e rCFIVED E-ig-bi [ � l MAR 17 202L - ‘ .____ Canrmonw,if{ /addac Of arviree F3UiLUiiVG UE `l,„ 11` 'r,q ficial Use Only . ...„. .. _ .. 6), - .V,,_,Zree �,h„f d ` Permit No, C.��Z-�2�-� /` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 1 00 PLEASE PRINT IN INK OR TYPE ALL INFORMATION) -Z City or Town of: Date: YARMOUTH To the Inspector of Wires: L!3y this application the undersigned--gives notice of his or her intentiontop perform the electrical work described below. ocadon(Street&Nu ter) 4 e r e Owner or Tenant I f-�� Owner's Address ' Telephone No. Ia this permit In conjunction with a building permit? Yes ❑ No purpose of Building_________ j21 (Check Appropriate Box) Utility Authorization No. !meting Service Amps / Volts Overhead ❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead dty, 0 Undgrd❑ No.of Meters Number of Feeders and Ampa London and Nature of Proposed Electrical Work: k-e , 0 ti tb Co 'kaon, the oil, ; table m, be waived b the In . No.of Recessed Luminaires No.of C o,o for o Wires. dl.-Sasp.(Paddle)Fans Transformers ora ev �� No.of Luminaire Outlets Na of Hot Tubs KVA r;� Generators KVA Na of Luminaires Swimming Pool d e ❑ e- 'o.o 'Units mergency r :ng 4�' No.of Receptacle Outlets 'd' ❑ Bette Units -,� No.of 011 Ratners FIRE ALARMS No.of Zones v. No.of Switches No.of Gas Burners. 'a o i 1 t? Initiatin Devices No.of Ranges No.of Air Cond. ° Na of Waste Disposers eat amp ,um r ozona , , No.of Alerting Devices Totals: ' __._.. eto.o on. n !�a of Dishwashers ---- DeteetbNAlertin Devices Space/Area Heating KW Local❑ 'an ie Na of Dryers HeatingAppliancesConnection ❑ Other y 1 ! ; o.o 'H Beaten KW `o,o `o•o KW No. f Devices or ' !nivalent S �a Ballasts Data Wiring: No.Hydromassage Bathtub Na of Devices or ' , No.of Motors TotalHP e ecomm ; ,ns „urh'a: OTHER: Na of Devices or • i trivalent Estimated Value of lac • I Work: 4/50Attach additional detail'desired,or as required by the Inspector of Wires. Work to Start: 3n 2 Z (When required by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the the'licensee provides proof of liabilityincluding"completed operation"performancecvcoverage or its subs al work may issueent. unless insuranceco undersigned certifies that such coverage is in force,and has exhibited proof f same to theesubstantial equivalent. The CHECK ONE: INSURANCE,] BOND 0 OTHERipermit issuing office. I card,jy.under the pains and 0 (Specify:) FIRM NAME: *pai/ Pe, - of "nry•that f a Information on this application is true and complete • e w 4f Licensee: „pl Si ature LIC.NO.: .S' (lfapplicable,enter„ ^ ' / Address: 6� a ., in the a ter lin. LIC.NO.: *Per M.G.L.c. 147,s.57-61,securi work ��n Bus.TeL No.• ay OWNER'S INSURANCE WAIVER: I am aware thes at the�Lii"en�does not have the liability Ainsurance coverage ' "/ Safetyblic ~S•'License: Lic.No. re94ir+ed by law. By my signature below,I hereby waive this Signature e Owner/Agent requirement. I am the(check one owner II ormally owner's a:ont. Telephone No.