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Home My WebLink AboutBLDE-22-004119 114) Commonwealth of official Use Only ��:,.' Massachusetts Permit No. BLDE-22-004119 = 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:1/25/2022 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 belo n 7„, Location(Street&Number) 98 SOUTH SEA AVE �� `r L �� Owner or Tenant Tom Martin Telephone No. Owner's Address 98 SOUTH SEA AVE,WEST YARMOUTH, MA 02673 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: Bedroom&bathroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 5 No.of Ceil:Susp.(Paddle)Fans 1 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 7 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Municipal Local 0 Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Eauivalent Heaters 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 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 S eci I certify,under the pains andpenalties o (Specify:) fperjury,that the information on this application is true and complete. FIRM NAME: Licensee: Matthew Gordon Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 55830 Address:22 Station Avenue, South Yarmouth Ma 02664 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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)) ❑ owner ❑ owner's agent.Owner/Agent Signature Telephone No. 'PERMIT FEE:$75.00 i PG �L# z� p O,r.I z ) ° ,,, 77t$ly,7 (Afarta -3B-.c4rrroLc ) (rt-cp,,„) l,4 7 zi� RECEIVED �µ it a-=• BAN 5 202�° .alb °f�I a< ar ,Tiff=_ Official Use Only L=/j_ p 1 __{-:iIL€�ING UEt r1kTMENT� °/ Sarvrces Permit No. t .y``'= - - ° _ 'REVELATION REGULATIONS Occupancy and Fee Checked I 'ev. 1/07J d DQI [�/t T11'1Rt r-�e" ,.,..: . " gave blank work to be `- --f t l - V ram- All U Km C L r /�� WORK performed in accordanCe with the Massachusetts Electrical Code t� ' ��`rl`2.0 `r O R K (PLEASE PRINT IN INK OR TYPE (MEC),527 CMR 1 z.00 City or To ALL INFORMATION / / L.5 Z Town of: YARMOUTH ) Date: By this application the undersigned ' es notice of his or her intention to perform the electrical work described To the Inspector of Wires: • Location (Street&Number) nbed below. V �a1 f^i Owner or Tenant fib M Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Box) Purpose of Building Existing Service Utility Authorization No. Amps Volts Overhead ❑ Undgrd New Service Amps / 0 No.of Meters _ Number of Feeders and Ampa Volts Overhead 0 Undgrd ❑ No,of Meters _ Location and Nature of Proposed Electrical Work: ill No.of Recessed Luminairesii Com.le_tion a the allowing table in. be waived. the Iru.ector o Wire No.of Total No.of CeiL-Susp.(Paddle)Fans No.of Luminaire Outlets Transformers No.of Hot Tubs KVA No.of Luminaires Generators KVA Swimming Pool Above 'a.o U ergency . ,nag nits No. of Receptacle Outlets :rnd. ❑ Qrnd. ❑ Bane No.of Oil Burners No.of SwitchesEBETMa No.of Zones No.of Gas Burners `o.of Detection and No.of Ranges Initiating Devices No. of Air Cond. No.of Waste Disposers Heat PumpTons No.of Alerting Devices Total umber Tons o,of elf-Containe.No.of Dishwashers Detection/Alert-ma Space/Area Heating KW MunicipalDevices No.of Dryers HeatingAppliancesL�❑Connecon ❑ Other No.of ater , Security Systems:* Heaters KW No.o o. of No.of Devices or E.uivalent No.Hydromassage age Bathtubs Si• s Ballasts Data Wiring: No.of Motors No.of Devices or E.uivalent OTHER: Total HP Telecommunications Wiring: �'� coo No.of Devices or E.uivalent bO Estimated Value of Electrical Work; 0 Attach additionsl detail: d f wired orc ys required by the Inspector of Wires. Work to Start: � �Z l� �� Inspections (When required by municipal policy.) INSURANCE COVERAGE:�' to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE licensee E des proof fliability lesstwaived by the owner,no e insurance including permit for then"performance of elis substantial al work may issue unless undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit g"completed operation coverage or its substantial equivalent, The CHECK ONE: INSURANC> I certify, under the pains nd a aI BOND 0 OTHERP t issuing office. �^P_ lres o 0 (Specify:) FIRM NAME: /Mq I ` , fPerlu ,that the information on this application is true and complete Licensee: b ( r LIC.NO.: tS �� (Ifapplicable rater"exempt' in!h license number line.) Signature Address. LIC.NO.; J "Per M.G.L. c. 147,s.57-61,se c no i� Bus.Tel.No.: --� INSURANCE W work requires Department of Public Safe Alt.Tel No.: OWNER'Squired law. WAIVER: 1 am aware that the Licensee does not have the liability insu —� By my signature below, cense: Lic. No. 5 Owner/Agent I hereby waive this requirement. I am ranee I Signature the(check one []owner coverage normally (" Telephone No. owner's a ent PERMIT FEE-- e