The URL can be used to link to this page

Home My WebLink AboutBLDE-21-002403 Commonwealth of Official Use Only 41. Massachusetts Permit No. BLDE-21-002403 '..+-' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.l/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:10/30/2020 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) 61 COLBURNE PATH Owner or Tenant LESLIE GOSSAGE Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (ChecPz :„„„. .. ...3Purpose of BuildingUtility Authorization N' asi Existing Service Amps Volts Overhead 0 Undgrd ■ Tr• 0 ' 1 ► New Service Amps Volts Overhead 0 Undgrd 0 pg*-,p). _____ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. Completion of the following table may be waived by the , tor of Wires. No.of Recessed Luminaires No.of Ceil: No.of Total Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool grade ❑ grnd. ❑ No.Batter Emergency Lighting 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. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Heating Local 0 Municipal ❑ Other No.of Dishwashers Space/Area KWConnection HeatingAppliances No.of DryersKW Security Systems:*No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. required Estimated Value of Electrical Work: (When by municipal policy.) y' 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 perjuty,that the information on this application is true and complete. FIRM NAME: GARY L GORDON LIC.NO.: 15290 Licensee: Gary L Gordon Signature (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 I PERMIT FEE: $50.00 I Signature Telephone No. 4 /4 ((i1// t L/j $41. 9 111111-1 P,J 10:loch[) R F C E / V E D sr)C9 yy� _ aen++nonwea of/ryassa,c T 0 L :S� • cial Use Only • E 4(j/ - J' .: BOARD OF ARE PREVENTION REG NS �� Fee�eCked ,� - fin (leave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code . r,,f i Y? (PLEASE PR OR TYPEALL INFORMATION) Date: (MEC) 5Z7 1Z00 dj 6 I, LA VCity or Town of: YA.R1VIOt ffi /6 3 i-` By application the To the Insp or of fires: Hejj2.i [fie sign gives notice of his or her' tendon to perform e:t7Acal work described below. f. Location(Street&Number) /t Owner-or Tenant i �-. C-$; )- Telephone No. ' Owner's Address <'e MA Is this permit in conjunctio with a permit? Yes 0 Ni?`' (Check Appropriate Box) itrf5f 1 Purpose of Binding �( Utility Authorization No. Existing Service/C '` Amps f I?G Volts Overhead Service 7 New Service ❑ No,of Meters Amps I Volts Overhead Undgrd❑ No.of Meters Y) 1 _ Number of Feeders and Ampadty Location and Nature of fPProposed W j`" , Cap/7 Ietion of the following table may be waived by the 1 No.of Recessed Luminaires No.of Cell. No.of for o Wires. -Soap.(Paddle)Fans Transformers Total KVA t No.of Luminake Outlets No.of Hat Tabs �� KVA V v� No.of Luminaires Ssg Pool Abov d' e ❑ In- No.of Et; i i g umg v No ofmod. mo $a9IInits Receptacle Outlets No.of ORBurners F c ALARMS 1No.of Zones 1 t b No.of Switches No.of Gas Burners �No.of Detection and a No.of Ranges _a Initiating Devices No.of Air Cond. To Tons n No.of Alerting Devices - No.of Waste Disposers Heat Pump I Number I Tons J KW No.of Self-Contai Totals: Detection/Alerting Devices _ - No.of Dishwashers Spac efArea Heating KW' Local❑Municipal U No.of Dryers Connection ❑ ' r rY Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent _V Heaters KWNo.of Bata Wiring; Signs Ballasts No.of Devices or Equivalent No.Hydromass age Bathtubs No.of Motors Total Hp Telecommunications Wiring-. O I HER: No.of Devices or Equivalent • Estimated Value of 1 �y �� Attach additional detail rdesired or as required by the Inspector of Wires. '� Work to start:� (When by municipal policy.) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless .1 the licensee provides proof of liability insurance including°completed operation coverage Q undersigned certifies that such coverage is in force,and has exhibited P eor its substantial equivalent The CHECK ONE: INSURANCE IT BOND i fy:) of same to the permit issuing office. � I certify,under the pains and penalties o ❑ OTHER ❑ (Specify:) ti)t FIRM NAME: O ��ury,��that the information on this application is true and complete. leciri G NL LIC.NO.: Pa42re? Licensee: 4, er el"' Signature (If applicable,enter" t••. rcense mrmber 1' 4 � LIC.NO.: . Address: 37 r ��J� _r�r rn�, Bns.Tel.No: J `Per M.G.L.c. 147,s.57-61,securl requires Department offPublic Safet} 'S"License: ��Ti'No.: t — OWNER'Si requiredIINSURANCE WAIVER I am aware that the Licensee does not have the liabilityLin.No. by By my signature below,I hereby waive this insurance0owner coverage normally Owner/Agent requirement I am the(check one ❑owner ❑owner's a ent alSignature Telephone No. PERMIT FEE: ,S 5v.—