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HomeMy WebLinkAboutBLDE-21-006052 0 Commonwealth of Official Use Only Permit No. BLDE-21-006052 ;,_ Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.I/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:4/21/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertortn the electrical work described below. Location(Street&Number) 22 MUSKET LN Owner or Tenant Gary Babineau Telephone No. Owner's Address 22 MUSKET LN,YARMOUTH PORT, MA 02675-2127 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 _T Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement air conditioning system&install exterior receptacle. 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 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Tons 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 Securiq Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters 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: (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: GARY L GORDON Licensee: Gary L Gordon Signature LIC.NO.: 15290 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:37 BILLINGSGATE DR, DENNIS MA 026382234 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 signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 „/s' Permmt No Use Only ervices .. BOARD OF FIRE PREVENTION REGULATIONS 3'and Fee Ch 1/o7j beat I 1 0 . _,., ec 1 APPLICATION FOR-PERMIT TO PERFORM ELEC• TRICAL ctCU WORK (PL ASEPRIN!'DVD�OR TYPE ALL INFO Code ,527 CUR 12.00 �y or Town of: OUR Date: ' By this application the gives notice otitis orlher� TO� . Location(Street mon > : Number) 1(kg - . ,_ described below. Owner arTesant :.� /� — C� r0” Owner's Address Telephone No. ... Is this permit in conjunction -a , ofBuilding__.S�_�� � , Yes 0 . N°,J2' (Cheek App�tt Box) - Purpose �j � UtilityA No. Serve Amps/ayzaVotts Overhead UadNo.of --- Amps / Volts Overhead s � grd❑ M Nuaires-of Feeders and Ampadty :� U° ❑ Na of Metas Location and N N . of •P _ ` /ei n -- ,_� .e..0-Fr--- _ �� ' E triad Woric ©tioc�tt' �:�; L :11(.., �A. --' ,►/ 'err � �� �z'�1�: Burners ' a Recessed LuminairesNo.of Celt.-,Snap,(Paddle)Fns - a fi d . • 1�rs: O , rt s OatleOutletsT ' mas KA . . Geserahms -- o.of Leamdmaires v ►a of �g Pool 1� 0 ❑ E _ KA Outlets o.of OR Thrift % Ne.ofS pHtBAIS 1 No.of Gas Burners is o -- • , f .y. No.of Ranges =' ;.,,,_Devices of Air Cond. Teat ►,a ofAlerthrg Device: No.of Waste Dors ;r- .T No.of T°tals: h 1`0. v, _ ... Space/Area H ► Devices . ` . ' .. o.of Dryers Heating Appliances focal[� '5$. ❑Ott .0.C "atm- KW ��/ Heaters KW o.o .0.O No.of 1 --•or -�,t Ballasts ' Wig: • �� No.Hydromassage Bathtubs J . No,of Devicesor strident OTHER. o.of Motors Tota!HP --mm, , , `if-, , r of Devices or , ; Estimated Value of E qr0 &r«1r uYona►d relined or as o Work• Start ( rimed by municipaespired l 1 ��'� _ t INSUInspections RANCE be wed in accordanx the URAN provider proof of "Un1es:wed by the woe:ao permit for the MEC with Ride 10,and upon you ce- p thatcoveragebilitY ill ranee including"completed operation"coverage or tel►. Mien Q CHECK ONE: II� SURANCEIT BOND ❑ ani as d1h' a fy:) same to the petaut; �stantial°q°w�eqt The ander the ,o0 4 FIRM NAME, pains and filmy,that the&forte on ' Z. •O * tIl�-r �, t G aPP orr is trove and fete. L 4 - S�tm-e ��, LIC.NO.: 1..c ...21110 • dry: ,: j LTC No.: J 'Per M.G.L C. 147,s.37-61 .- � Jam/�E � " �f' ill- >�TeL N .- - .� Per M-G. e• 147, NCB wwivgtt: I t of Public - s"Li air.Td.No.: qr/ wed hY law. Byaware that the Licensee does not haveLG NO- <� S my striatum below.I hereby waive this . I am the thechee o n e evera�°O s Agent j 0 owner ❑owner Telephone No. .sr I PRA1LlTr aaa_ ..