HomeMy WebLinkAboutBLDE-22-001499 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-001499
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: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) 33 RUNE STONE RD
Owner or Tenant CRAWFORD JULIANNE Telephone No.
Owner's Address 33 RUNE STONE RD, SOUTH YARMOUTH, MA 02664
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 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- ❑ 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. Total No.of Alerting Devices
Tons
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 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
Ot•Lb' 11(415'1
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-..,„,, 1 SEP 15 2021 i -
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Official Use Only
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4001._LJIhC A 'v1
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- BOARD OF FIRE PREVENTION REGULATIONS Fee Checked
.1/07) - blurt ` -'
APPLICATION ICOR:PERMIT TO PERFORM
ELECTRICAL WORK
All work wbeperformin htheM
IPLF�ISEPRAT IN INK OR TYPE ALL INFO Code i �/ �, r l2.Oa
�or Town of T��T701►�
By this application or the 0 V 1 Tot a ../
SKr /�.M �
Bythis et& n ofbis arher �' •�
Pim the- .,--1 work led bebw.
Oweer erTera� � �
Owner's Address Telephone No.
Is this Pik is co with perudt?
Yes
0 Ile vm'
(Ciecr Appropriate
rlate sBoExisting
x)
purpose of gigUtility Authortiation No.Sarioe4l' Amps Zili / Y� ��ndW paw❑ No.ofMeterAmps / Yoh: Overhead Usdgrd 0 No.of Meters
Neaber of Feeders and Ampachj
Locatlon and Nature of Proposed Electrid Worfc •of• .:I / 4
.
• Aziiiiof Recessed Luminaires No.ofCeh,.S•esg{Paddle)Fans ate,,
O1 o.of Lam Outlet KVA
V o.ofi, SPool 0 ❑ _GelleratisisKVA
O N.e.of Receptacle Outlets o.of Oil Ruiners FIRB Uiri4r 11F-7,7',1 ,
of Switches
No.of Gas Burners _ 1 'SII ....4 .S
No.of Ranges
of Air Cold,
Waste Disposers . - Total= ►• � t *ices
No.of Tors a of
N0.of Df vrasb� SpacefArea H�g.g
V o.of Dryps KEN Lacat❑ ' " '�"a, 0 Other
H _ ,a.
'o.o "atv eater t� Kw a- - .,,,,,•
��/ Heaters •Kw `o.o o.
Ns.of► or t
.
No.BPdromass " Ballasts
age Bathtubs o.of Motors Total AP _ No.of Devices or , :lent
OTHER:
Na.of Devices or _ , ,- _ ,
Estimated Vatoe of Attack
atlinrrai d®rafl ..
O Work to Start /3 � m •by Policy)reggdred� arof tPnrs
Work to NCB GE: Inspections to be requested in with MEC Rule 10, the
Provides macron,permit for the moa
OTHER
ved
nce of electrical work may•
dic licensee
ity insurance inchiding ucompleted operation"
- -i *aligned celtifies that such
ia
cmenge
ov in force,and has • f °I'it'
ng
office.
end
The
me to the Pemitn `K BOND 0 )aj andr the P s ofPQJnrJ,thee the information. oat erftrueand coapde9 'FIRM NAME: ._ O - c" GIC NO.:ctsd2w- .c. "1-# Signature t��► LTC NO.7h -_ #1 / a =wddrssss ,�
dt
ir
- _J *Per M.G.L G 147,s_57-61, -- ,, l2.•Ile 0 - P'rr JTjAit Tel.No••
-e required b�INSURANCE A7ygp I aoraware tiequires oftbe publicdoe, •_ Tel.No.; QI'/
Signature
Y my sigma:*Wow,I hereby waive nor have the Lie.No. fJ
e(cheek
TekpLoae No. owner o s
1 PFAJI!rr ria_ -