HomeMy WebLinkAboutBLDE-22-001500 Commonwealth of Official Use Only
fiAlkP44Massachusetts rrmit
No. BLDE-22-001500
BOARD OF FIRE PREVENTION REGULATIONS ccupancy and Fee Checked
v.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:9/15/2021
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) 59 DANBURY ST _Ca . 314)-3. 15 Z
Owner or Tenant JOSEPH FRED E JR Telephone No.
Owner's Address TOOMEY BARBARA A, P 0 BOX 526, REHOBOTH, MA 02769
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
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement HVAC.
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
Initiatine Devices
No.of Ranges No.of Air Cond. 1 Total 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 Eauivalent
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:
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 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: $50.00
Op 0 1444 teg, Cmivl)t7 . - A /AI
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RECEIVED
1 _
,. SEP 15 2Q21y
�' )INCA ;,Krn1E 1 . , O�eialUse t)o1y
-
` .;, = oARD OF FRE PREVENTION REGULATIONS Fee Cn�---
APPLICATION AOR`PERMIT TO PERFO wankwank ,_
Allwork to 6e is is savor the RM ELECTRICAL WORK
(PIF.A.SEPRpyT�yINK ORTYPE.ILLINFO '. ,y « I. 12.00
�y or Town of O � Date: 41"" s—
ectrical Cede
By appbdon the pip 9 notice of has or ber To , ." o mss:
_ Lin(Street do Number) .....1-4' ' / to Perm the l described below_
owner or Tem �E�
owners Addrew _ Telephone Na
Is liens permit is crow with a
Pel Yes Q
PurposeofBudding
Utility Appropriate Box)
Exisdag Service/6 p Amps/ , V Overhead M
�"__ Amp -- Overhead U ❑ No.of Met
Naaber of Feeders and Voice Uadp�❑ Na.of Meters
Location and N;. of Proposed g S ' % ��t/,
werla
S
,, , . .:. , de,4,;_.,„.,...._ e _p.
do
• Winn
nI a of Na of )Falls dornmers NAa of Luminafre Outlets
•■a of Luminaires
Poot 1 � aV
Swinnning
0 no
Receptacle
• p a of OR Burners
p1,of Switches " ALARMS AIMMal
Na of Gas Burners •_ - v
1. ..
No.of Waste Disposers _ of Toss )`o.efiltez g Deices
No.Of Dishwashers
Space/Area H Devicesodr o.of Dryers H KW- Lemd C1 r_g. El
"o.o a0er a minces ,
�1/ Heaters -KW `o-o ,o.o Na.of -- or
S•J •. Ballast:
i IoW t .
No.Hydromassage gibs o.of Motors Total Na of De fres or ' , : _
OTHER HP
No.of Devices w- , ,;
Estimated
value
of .,- Wt ✓ Anoeh ad -
O Work to Start -_ (When by municipal �required by the Impactor fW ;
IN erections to be requested
. .i the bcensee provides proof� • the owner,no �MEC ��,and upon moa
�dasior the electrical
Q ats tha NC t h comae lain exhibitedProof of same °r its egm"ieat: The aC - r �dseP�s sas(�BOND 0 OTS 0 �P�fy:) Pmt office;
P of
Q FILM NAM$; aiT,that the information an fox Is true anad
Licensee ` ` g o a, G L- le �/
glc ase enter"_•..,. - 1 ense /` ' Signature _��i UC NO.: /,.S 90
'-
Address: ,� j "a, LIC NO
J *Per
M OWNER'S W 147,&57-61,..-_„ A. a/Q!ve 4' - O"r j Ate" Bas.Tet.N
��INSURANCE W� jam�t requires the of Licensee public
ices ha �R Tei,NaTr
,
Agent By my signature belowmaw
. hereby waive not the -,,,�_
I) - I am the( oma °O
Tafel*"Na owner °O�1tY
PRP 1tes•r can_ .