HomeMy WebLinkAboutBLDE-22-001498 .�.,�� Commonwealth of Official Use Only
fi.: '�' Massachusetts Permit No. BLDE-22-001498
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) 405 ROUTE 6A
Owner or Tenant WHITE SALLY C Telephone No.
Owner's Address 41 NORTH MAIN ST, 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 ❑ 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 A boved. ❑ grnd. ❑ No.of Emergency Lighting
rn 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/Alertinu Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No
No.of Devices or Equivalent
HeatersWater KW No.of No.of Ballasts Data Wiring:
Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail iV.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. I PERMIT FEE:$50.00
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n _cial Use Only
__, . •• • + 'REvgNTION REGULATIONSU0t and Fee Checked
APPLICATION �QR=P�R accordanceM ,_ blank ----
� Prx �` `'� j mthe�� ELECTRICAL
\� .max M TYPES 1NFo coax t zoo WORK
) 6 By this City or Town of O.0� Dates /�'
application v jt1
Location(Bhpd:lVn gives notice ofhis arher pc a m o Wires:
or Truant • Q s/4 r calc dyed below
V\ 1 ` OIOwner's Address �`� r'
Telephone No.
Pe titin conjunction with a
k \N ExistingPae of Buildingb P Yes ❑ No (`i r (Cheek A Pl►r<►prlatt Box
Senioe�& / Utll ty . ion Na )
O VslY Overhead
� Natasha-of Feeders and - ---Volts Overhead U
Location and Nature of�� �❑ Ni.of M
‘, .
das •
� .. .:._ ` de . -
1 e.of Recessed Luminaires
• •
Transforme
atlets
CIMME
es
KV aofL Generators KVA.. of[ �mhagp� ,,. ❑ ❑ 1'a ,Vo.ofReceptacle
p No.of Switches
o.of o8 Bmne!s
Na.of No.ofCas> S ►, 'AIAR r
of Air Cond.
r.i ; �
o.of Waste DisposersT � gOes
• _-. ,, , �^� Tons •o.of
No.of Dishwashers Totals: l' f � , ''D
Space/Area ' ,
?V No.of Dryers Best KW > ❑? a
o.o i`aver BeatingAppdances , .t..-. 1 , , . "❑ptkr
�V Heaters KW 'o.o
Na.Nof
S.., o.o orL. ,• ,,t
No.Hydros s Bathtubs o.of Motors _
Ballasts Willing:
OTHBR; Total No.of De or ' , t
it. No.'uf _,
Devices or : ' ,
Esdamted Value of -, Wox „ �
Q Work to Sty — itdelall r° +md lira`' the I
Ntrt ,z'?� ass to be requestedin Policy.}r ++edby °fWre, .
211 �° proof ofliabnioniop waived by owner no pewit for thepa ormanew-MEC Rule 10,and yg,on won.
theof
—Iv°11c may issue. micas
Q I1�SN ndersigned certifies that such covatage is isZeinding as e "coverage(sr
aC - 'the p r mid p of 0EIT BOND 01— ❑ (Spay f-- same b the
p osubstantialffice.
elahala"�ted
The
Q NAME: a p rpgry,that the sr:form en
.. C -S4J�.r ,, [ aPPDcedosr is tare and OOmPe
rC x]:
L �2 j0Licensee
r oche:a '` : - n Af�y t
•
•
c.
SURANCE
requires
DePa
it-1 Licensee V fir lyl .rJ M.G.L. s.57-61, L el.Q,ORxR' wv ; t t°fPublic
l.c.No.requiredby>aw fmYsignature
batI t ' lvathe herebywaive tins requi t. I am the(Check owseoveragesrOwner/Agent
u' Signature
TNeSoae No.
ant
- PFI?ltltr Garr_ .,