HomeMy WebLinkAboutBLDE-21-005807 -XV Commonwealth of Official Use Only
t: , Massachusetts Permit No. BLDE-21-005807
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:4/8/2021
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) 35 CHANDLER GRAY RD
Owner or Tenant Doreen Corino Telephone No.
Owner's Address
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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace switches&receptacles. Receptacle for stove, microwave, plug strip,
dishwasher,&fixture.
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 rnd e ❑ In- ElNo.of Emergency Lighting
g grnd. Battery Units
No.of Receptacle Outlets 10 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 10 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges 1 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/Alerting Devices
No.of Dishwashers 1 Space/Area Heating KW Local ❑ 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 Data Wiring:
Heaters Signs Ballasts 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
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
"�/ co,. orsmsa[th
a �a Official Use Only
_' = �`P ..3ervigct Permit No. �2( - )CO d
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h / BOARD OF FIRE PREVENTION REGULATIONS • .iio and Fee Checked-----____
cave bleak
Ala f APPLICATION FOR:PERMIT TO PERFORM
MI�tobe accordance with the Electrical CEdLECTRICA WORK
0 (PLEASEPRINTININKOR?YPE ALL INFORMATIO t 12.00
NI Date:
‘ � 6 �y or Town of: � �
- By this application the gives> of To the I of Wires_
on to Location(Street&Number) `� performelectrical work decrrbed below.
r cif Owner or Tenant �'-/� ��
Owner's Address Telephone No.
r� �this permit in coajna n with
7 Purpose of Buitfiiag .( JeNi r Y� DU I!Ia ] tCheck Appropriate Box)
tq g Service �j9 Authorization No.
�I / Amps/ Vohs Overhead ° Undgrd❑ No.of Meters
New Servlte Amps I ir
Number of Feeders and Ampacit�' / Yohs��f 0 Undgrd❑ No.of eters*iv
—
Location d Nature of Proposed • -�' C�' L'_/j /.l �?'���� .J;�-
furic
No.of Recessed Lumina' tres ..L,. �.., the ♦ e4 �
No.of No.of Ca.-gasp.(Paddle)Fans T, o, ,
tansformers
Q wire Outlets No.of Hot Tubs Generators KKVA
VA
No. Luminaires of
V Swimmm ,g Pool • , ❑ • 0 'o.o �cY a 1
No.of Receptacle Outlets ® No. - - "•- Uafts •
O of Oil Burners
p No,of Switches . FIRE No.of Zones
No.of Chas Burners .a. ,1 e _ ...,
No.of Ranges No.of Air Conti.Nik
< `
No-of WasteDisposers Tom No.of Alerting Devices •
. i,Totem ____ ors
_ DetIOn/r ..
No.of Dishwashers Device
SpaceArea Heating KW- I I '- < .. i
., No.of Dryers Connection 0 Other-
Heating Appliances ,
• 'o.o "ater No.of r ,_ or alert
_V Heaters KW o.o B�o Data Wiring:
Si a, No.of Devices or ,<
_ aivaleat
No.Hydromassage Bathtubs No.of Motors
Total HP - =- atmn, cottons 'fwing:
OTHER No.of Devices or '< ,' dent
•
Estimated Value of E I M I M "� / ltltodh tionol detail r red or as by
Work to Start W or b (When required by>micipal Polio}►)required the rn peaor ofWi„e,.
WSUR 'c ,, Inspections to be requested in accordance with MEC Rule I0 and
the INSURANCE
provides proofE{ Unless waived by the owner,no permit for the performance of electrical upon
completion.
the licensee
i certifiesinsuranceity including competed n may issue The
O that such coverage is in force,and has exhibited operation coverage r its substantial office. The
Q CHECK ONE: INSURANCEIT BOND ❑ OT 0 (Specify*f of same to the permit issuing
Q[ I certify,under the paitrs and penalties of pe jury,that the information on this
Q FIRM NAB' �2Q o v-�'ar�1' / app�otr is true and complete.
t
Licensee: el.'el.' C.- C.-` LW.NO.: /��fp
(dapp le,eruct•" Signature LIC NO.:
Address: license
menber
OL/(/Ef Bns.Tel.No-
1 Per M.G.L.G 14Z,s.57-ti l, m9 Aft.Td,No.:
requOWNER'S INSURANCE W res Department of Public s"License Tic.No.
i— required by law. By my signature I am aware that the Licensee does not have the liability
Ow by gesture below,I hereby waive this re uirement T am the(check insurance coverage normally
Signature _ owner's eat
Telephone No. PER 447T r:un% 0