HomeMy WebLinkAboutBLDE-21-004584 or Commonwealth of Official Use Only
A - Massachusetts Permit No. BLDE-21-004584
11 -,7.-
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:2/12/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 63 WEIR RD
Owner or Tenant Shalamar Brown Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check:4;7,P rig'
Purpose of Building Utility Authorization No. O
Existing Service Amps Volts Overhead 0 Undgrd ❑
4,..
4 �1New Service Amps Volts Overhead ❑ Undgrd ❑ ' _ 467 a
Number of Feeders and Ampacity ' q '
Location and Nature of Proposed Electrical Work: Replacement furnace.
Completion of the following table may be waived by the , ., Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Tot:
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
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ 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 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) 0 owner 0 owner's agent.
Owner/Agent
Signature _. Telephone No. PERMIT FEE: $50.00
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!I � a sRE o�„yi�, • Pecesrmit No. —4-Q�
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BOARD OF FIRE PREVENTION REGULATIONS •Oct'and Fee Checked
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APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK
All work to be performedin accordance
with the Maw ElectricalCode i.,,:. 527 P,, I' izoo
O
f, dell/ (PLEASE PRINI'IN�OR TYPE ALL INFORMATION) Date:
,/ City or Town of:. OUTH
By this application the p � notice of his or heroin
er mtenti To the I .. aj o Wires:
' Location(Street&Number) • on _ ,• 1 woti;„....described below.
,
Owner or Tenant i L 1.,1 C ..._
Owner's Address /nik ~• Telephone No. = as
Is this permit is cronjmZctio with a , „ ,,;, . , - ._
Purpose of Building ,' ...
Yes N _ a (Cheek Appropriate Box)
Existing Service/AA Utility Authorization No.
Amps/c 12i volts Overhead
Neer 'ce A / Volts Overh • Uadgrd No.of Meters
Number of F� andy Undgrd❑ No,of Meters
Local, ,d?inborn of Pro. . Elm Work / d � �� <{
_i KIIIWC-v rte '
No.of r..,,., _. • the
naires
o.of Luminaire Oatleli No.of Cal.-Shap,(Paddle)FansTransformers
Win=
No.of Hot Tubs KVA
o.of Lam a Macs KVA
�t;o.of Receptacle Outlets S` Pool 0 0 :°:.!
; , rgeaCY P75 .
i7aits
Mienni
.%)
IZZOMMI - No.of OB Burners ERE ARMS
No.of Gas Burners P S.o i - , ,
i No.of Ranges -
No.of Air Cond. '
No.of Waste Disposers .• _ J Tone a o.of Alerting Devices
Totals: am, ons Mang
• •
•
No,of Dishwashers
U
No.of
Space/Area Heating KW' a-. �, Devices
? els Heating Appliances ,,...,.Local 07 0 other
ectioa
o.o 1'ater KW ,
_V Heaters -KW `o.o .0.o No.of c ^.., or cleat
No.Hydromassage S ' Ballasts +ata Wiring;
Y massage Bat�bs No.of MotorsNa of Devices or ' �oiralent
OTHER: Total HP -ecomma cations ,f
Na of Devices or : ,civ
Estimated Value of 'cal Wor1c `�—' Amick°b derail if derired;
tiWorkto� GE: barons to be requested in ce� p°�'0�red by the In eerror of Wires. .
� MEC Rale 10
C the licensee Unless waived by the owner,no ,and upon rpleti •
su
provides proof of liabilityUPermit p the performance of el
O ����certifies such ts in tnsurance including �pl� �„��"�echtcat work may Issue tailess
Q CHECK ONE: that force'and has exhibited proof of same to the y equivalent
'
I Order I e N IT BOND ❑ OTS 0 (Specify:) Pmt issuing office.
FIRM NAME: Pis and P o fpQjeT,that the infar oa o
License k 0 Gly�' `, r C.-
a app asriort is trove and complete.NO.:
•
0-applicable.
eater". je Jae r an Signature _x`11' LIC. I���Q
�� j LIC.No.:
j Per M.G.L.INSURANCE s.57-61, „ :.,, "_ Dir(le 1pu - a�r /u-• Bas.rel No:
OWNER'SRANCE W requires t of Public Alt:Tel.No.: �"
red by law. By my signatureWAIVER: I am aware that Lim does nor bare the Its Lie.No. <,
I requirSignaed
by l Owner/Agentherby waive this re4ui t I am the{check co � °O
11
c:! °w°er oarner's
TeleptioseNo.____ PERMlT nca. .. gat