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Home My WebLink AboutBLDE-22-001402 Commonwealth of Official Use Only Ems, Massachusetts Permit No. BLDE-22-001402 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) 95 PHYLLIS DR Owner or Tenant Jesula Chafles Telephone No. Owner's Address 95 PHYLLIS DRIVE, 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 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 furnace. 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 Initiating Devices No.of Ranges No.of Air Cond. Ton l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ 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 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 (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: $50.00 R C E i v E D ' ._ m..Ep..1.� 20Z1 . lit Ai } UiNG UHF ARl t1. ,T.. Official UsaOdy - BOARD OF FIRE PREVENTION REGULATIONS p and Fee Checked • blank APPLICATION FOR=PERMIT TO PERFORM AU work to bepe aced in with the MawElectrical q.ELEC 122L WORK ( LEitaPRINT 11I LW(OR MEALL 1NFORAL412010 Dates �y or Town of _ARM�ITT$ /a Location application Nu notice of his as won to pe�foimwork electrical of described below. Owner or Tenant -' �'� (/ Owner's Address Telephone Na Is this permit in co - Purpose of Starling . Wo withExisting ding per' Yes 0 No 0 Appropriate Box) I Serrice�4� Amps/ Volts Overhead A Na Overhead II 7Undgnin Na of Metaxs Amps Volts O�- Nuinber of Feeders and A 0 IIndgrd❑ Ni.of Meters Location and Naiture of Proposed Electrirol Work of Recess LuminairesNo.ofCeR,-Sesp.(fie)Fans ' o.of Lam 0u No.of Rot Tubs KVAa ofr .aII_VNa of Receptacle Outlets - a ofO�BurnersQ FIRE ALARMS :mom:III" . • _ • Nk of Air Cont. a of Waste Tons a efAlertiag Devices ons No.of Dishwashers �r Space/Area Beating KW' Devices - ? ' In V Na of Dryers H Local j� 0 Other- ? Appl antes n ` ,a o �'ater KW 4 _V Heaters -KW `o.o a o ► , S', Ballasts a to fig, Na of Devices or No.Hydrgmassage Bathtubs 0.of Motors Total HP Went OTHER: No.of Devices or , ,, Estimated Value oft . W "kiwis°° daily d or as reguhod Workt Start — uric, (When required by muucipal policy.)Inspecticas by Inspector of Wires. Work to INSURANCE •o .i GE: Unless to be in w�MEC Rnk 10,and , issue unless • "a proof of3iabi y by the g" no permit for loe performance of electrical �, The p that such coverage is in operation"completed ' a its substantial 4 CHECK ONE: INSURANCE BOND and has exhibited proof of scut to the p office. OFIRM NAME:the pains mid pesticideso fpCr aT,that� information o this GPP�on is O * d..Lf �' s G ` true and a NO.: `,� (II4PPe carer" -Licensee Signature NO: /3 eZ�j3 Address: t + NO.: J OWNER'S C. 147,s.37-61, requires Departmem of Public04 r rn Bats.It Na .< required SURANCE WAIVER: I am aware that the Licensee does nor S~the iab iit Alt raty n,lYo.. by law. By �.No. Owner/Agentit mY llatan below,I he eby waive this I ame cha clner owaer IJ Te1e�6one No. (PRR torn warm._ .