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Home My WebLink AboutBLDE-22-003031 4) Commonwealth of Official Use Only 'L ;' Massachusetts Permit No. BLDE-22-003031 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:11/24/2021 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) 3 CHECKERBERRY LN Owner or Tenant ALBERS KIRSTEN Owner's Address 3 CHECKERBERRY LN,WEST YARMOUTH, MA 02673 Telephone No. 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 New Service gNo.of Meters Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler 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- I: No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and No.of Ranges Initiatine Devices No.of Air Cond. Total No.of Alerting Devices Ton No.of Waste Disposers Heat Pump I Number I Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of Heaters No.of Ballasts Data Wiring: Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. (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 I certify,under the pains andpenalties o (Specify:) fperjury,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.) Address:22 Station Avenue,South Yarmouth Ma 02664 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 t ol4 t161 zv CCit‘345 40 ! t? F., F I V E D ! Aftely i I C -- -. icea , ,_ Official Use Only VT /onnwwaaath �a�h �, ■ ' r �I( ` t� nn Permit N C_ 3 �spartirunf o �iro Jirvtcte PC i ;, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked APPLICATION FOR PERMIT TO PERFORM I/07] leave blank '--- All work to be performed in accordance with the Massachusetts ElectricalRM ELECTRICAL WORK (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) (MEC), 27 CMR 12.00 City or Town of: YARMOUTH Date: // 2.,2 "2- f By this application the undersigned gives noti To the Inspector of Wires: of h's or her intention to perform the electrical work described below. Location(Street&Nu ber) 3Che[�@l be Owner or Tenant �- , rr A h e 5.-hkl bars Owner's Address Telephone No. Is this permit in conjunction with a building permit? y� Purpose of Building______________❑ No.® (Check Appropriate Box) Existing ServiceUtility Authorization No. Amps / Volts Overhead D Undgrd ruler "—"New Amps / Ell No.of Meters _ Number of Feeders and Ampacity I Volts Overhead 0 Und rd g El No.of Meters _ i Location and Nature of Proposed Electrical Work: r e ,,t,;r eSri, o, e I nlj. No.of Recessed Luminaires Completion o the ollowin, !able m be waived b the/ns.ector o ]fires. nacres No.of Cell.-Sus t No.of Luminalre Outlets P (Paddle)Fans o•o KVA ` No.of Hot Tubs Transformers ,"t No.of Luminaires Generators KVA Swimming Pool ,r'ove ❑ ,nnd. ❑ 'o,° mergency g ng �` No.of Receptacle OutletsBatte Units "', No.of Oil Burners No.of Switches FIRE ALARMS No.of Zones t�. No.of Gas Burners 'o.o etec on an No.of Ranges Initiatin Devices No.of Mr Cond. ota No.of Waste Disposers `eat 'um Tons No.of Alerting Devices p 'um.er Totals: ...._.......•.._._....... o.o e - cots ne. No.of Dishwashers Detection/Alertin, Devices Space/Area Heating KW 'unc a No,of Dryers e Heating Appliances KW Local Connection ❑ Other "aecu ty ystems: Heaters KW ° ° •o o No.of Devices or E uivalent No.Hyd Heaters Bathtubs sins Ballasts Data Wiring: No.of Motors No.of Devices or E.uivalent OTHER: Total HP a ecommun ca.ons " r 1 g: No.of Devices or E B.uivalent Estimated Value of Electrical Work: �f Attach additional detail if desired,,or as required by the Inspector of Wires. to Start: 1 (When required by municipal policy.) WorkSURANCE COVE Inspections to be requested in accordance with MEC Rule 10,and upon completion. RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue hies ounl "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 issuin ess the licensee provides proof of liability insurance including CHECK ONE: INSURANCE BOND I certify,under the p ins and p a ' OTHER 0 (Specify:) g office. FIRM NAME: jperiury,tha the information onthis application it true and completes Licensee: W!q ' �o o el �� '" Signature LIC.NO.: � afapplicable,e ter"exempt"in the lie4 ""----�— Address: e nu er line) LIC.NO.: *Per M.G.L.c. 147,s.57-61,securi work y4VN Bus.Tel.No.: rk requires Department �eQ G 7 7 WAIVER: partment of Public SafetyAlt.Tel.No.: OWNER'S law.INSURANCEy y signatureVER: I am aware that the Licensee does not hve the liability Lic.No. Owner/Agent ela below,I hereby waive this requirement. I am the(check one q ty insurance coverage normally Signature i1♦ owner I owner's a: Telephone No. ent. PERMIT FEE:$ SO —