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Home My WebLink AboutBLDE-22-005772 Commonwealth of Official Use Only (fi / Massachusetts Permit No. BLDE-22-005772 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:4/11/2022 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) 162 OLD MAIN ST Owner or Tenant Carla Sharrow Telephone No. Owner's Address 162 OLD MAIN ST, SOUTH YARMOUTH, MA 02664-4524 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps Volts Overhead 0 Undgrd ❑ No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service 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 Initiatine Devices No.of Ranges No.of Air Cond. Ton l No.of Alerting Devices 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 Sinus No.of Devices or Eauivalent 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:) 1 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 (1/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 Signaturekilt:37,,r Telephone No. PERMIT FEE: $50.00 (Ct. 2 Ta ii I� AccuI ?(v2 9 ' ' ' EIVED '' ' APR 0 8 2U2 o saa of P7addac�Wea(fd Official Use Only __ a2Z--5772 ' =47,...i't c7 Permit No. .Z• 1. e ;,11, . L i.!I N G U E PA R T of o`}iro�arvicsd (� -..-:1.9 — Occupancy and Fee Checked . • ■ -' 'REVENTION REGULATIONS [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 12.00 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: `- / City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of hil 9f her intetnn to perform the electrical work described below. Q Location(Street&Number) 16 Z old /1l I otSS Owner or Tenant CQr14 SI,Arr-Ov✓ Telephone Nd3/1151)76 7 yy3 L Owner's Address 1 Is this permit in conjunction with a building permit? Yes ❑ No .® (Check Appropriate Box) Purpose of Building AIA 5-a-- Utility Authorization No. ll Existing Service / bt) Amps / Volts Overhead IN- Undgrd ID No.of Meters 1 )t- New Service 2 20Amps / Volts Overhead ' Undgrd ❑ No.of Meters 4- Number of Feeders and Ampadty Location and Nature of roposed EI l Work: Ne w Se r V i C2 wi('° l --o IC'6 , vv1G'1"el� o1V�O� qy�2 t Irl Completion of thefollowingtable may be waived by the Ins ector of Wires. oto . �! No.of Recessed Luminaires No.of Cell:Sas No.of Total ,-,/ p.(Paddle)Fans Transformers KVA _ '' No.of Luminaire Outlets No.of Hot Tubs Generators KVA A No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting grnd. grnd. 0 Battery Units � No.of Receptacle Outlets No.of Oil Burners �V FIRE ALARMS )No.of Zones No.of Switches No.of Gas Burners Prii.of Detection and Initiating Devices No.of Ranges No.of Mr Cond. onsi No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of elf-Contained Totals:�'" ' '"' "'"{ Detection/Alertin, Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters ' No.of Data WIring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail ifdesired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: ZO (�O (When required by municipal policy.) Work to Start: l'-Vs 1_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 BOND 0 OTHER 0 (Specify:) I certlfy,under the pains and; ides ofpert u.,they the information on this application is true and complete. FIRM NAME: �_,///4/ i . , 0 Licensee:kI I LIC.NO.:��5 -� • . . Signature LIC.NO.: (If applicable,enter"exempt"in the license num.er line.) Address: Bus.Tel.No.: 607' *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"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. p PERMIT FEE:S