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HomeMy WebLinkAboutBLDE-22-001403 Commonwealth of Official Use Only � , 141)'' Massachusetts Permit No. BLDE-22-001403 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:9/13/2021 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) 54 WILLOW ST Owner or Tenant NICKELSON MARIBETH C Telephone No. Owner's Address P 0 BOX 501, YARMOUTH PORT, MA 02675 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 Eauivalent 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 ❑ (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 kr,. 42 �n!� ii t Use eSEP 102 ZZ �PetmitNo C ®,��� � ,; _ _ t'AR, , .,. wet _..........._ 4 NGD __ . • , ., — - " .-is a F FIRE PREVENTION ,GOB'-andFeeChecked _ blank a1 APPLICATION FOR. :PERMIT TO PERFORM All work to be prs�inaccordance with the M ELECTRICAL 0 WORK a'L.E 3EPRINTI1yIN1COR TYPE. INFORAQTTOI /0 � �or Town at UULS� Date: d Clip application tie geed gives nonce dins or., To the eI or f k desc - intention to Perm the electrical \ )- 00 `� Owner orTasaat t) ` Owner's AddressAMIIIIPZIOr Telephone No. 1 , Is this permit in conjunction with Purpose o f � permit? Yes � N."�i" (Cheek Appropriate Box) Existing_"" `T� AmpsBuilding GAY Authorization- Na l� 1 .e voits Overhead ea a --. � / `a ° No.of Mew l volts Neither of Feeders and Ampa Overhead 0 Uadtrd 0 No.of Meters Location card Nature of Wor1C Cr Z4'/L 41 /_ " i of Recessed Luudnaires t Na of Cell.- .(paddle)Fans s rt EVA V R of Gam Swililming poi ❑ '`0.�a ators KVA ireall p No.of Switches o.of o Burners Na.of R No.of Gas Burners _• - - `,,a. ,AL _-_-:„S �, Air . No.of Waste Disposers t^ Cord. Tans •o,ofAt ,.,,,, -71 ti � T 1�0. w Ar „+_- No.Of D Dims Detection/ -i_ Devices U Space/Area Resting -7 : " a of Dryers KW- I'0�❑ ❑Other `� 'o.o "Ater Heating lea KW r a r1/ Heaters -KW `o.o .a o Na of •or •. : t <,� No.H 5 'atlases + to Wiriup _ IQ J age Bathtubs o.of Motors Total HP _ No,of Dever or ' ,Divalent OTHER: taoas «� No.of Devices or ., ,t • • Emoted Vatoe of E - �� addition?!derail N. Wove to Start; -r +/ 5 f required by m gp Poesii act ky)'equired!lithe tlx Inspector gyp. .. pINSURANCE �T"';TGE: to be requested in RuleMEC 10 and IN provides proof of -Unless waived by theOwner,ao Permit for the t j as *aligned causes that insurance inclndiog��PciPetatim,. eta�ric�aPanpt may issue Th unless Q CHECK ONE: INSURAI4CEIT BOND is in force,and hasD Proofofsameccivezage to the p°ids substantial yatent '1Tre © FIRM NAME; pins and p o fpe7a+y,that the fefor o O V- dJ '0. i G- this applicationis Dare a7rdcoaO: (jfaPP1t curter ey Signature G LIc NO.: 4s ��} • Address: '� t , • LIC NO j 'Per M.G.G. 147,S.37-61, r �!�� �T Jyjt� •TeL No- OWNSR'S INSURANCE W t of Public S S"License: Air:Tel.No.:. by . By mY WAIVER: I am aware that the Licensee does rot have No. t owse cAgmt gnaw below,Thereby waive this the oat insurance.' ea .`, Signature I am the(check a� owner ily - .TeiepirneNo. owner's Dent, PRRsor r ana-