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Home My WebLink AboutBLDE-22-006496 ei Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-006496 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:5/11/2022 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 describ 1.ell`ow. Location(Street&Number) 176 SEAVIEW AVE _ i Owner or Tenant Te .phone No. Owner's Address 176 SEAVIEW AVE, 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 HVAC. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners 1 Initiating Devices No.of Air Cond. 1 Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW Local 0 Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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. .G2� •�� CHECK ONE:INSURANCE 0 BOND 0 OTHER CI (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 LIC.NO.: 15290 Licensee: Gary L Gordon Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:37 BILLINGSGATE DR, DENNIS MA 026382234 *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 0owner's agent. signature below,I hereby waive this requirement.I am the(check one) 0 ownerI Owner/Agent I PERMIT FEE: $50.00 Signature Telephone No. RECEIVED kj ,& MAY 10 202i pp`` y�j 'F.o Goa of r//aeeachudatie Official Use Only Tt ;/ c�77 n�7 Permit No, CV— f� lg ce, r .: .„ i„ DING D E PA R T M • (mod° iro Jarvicse • f' Occupancy and Fee Checked :•ARD •• " 'REVENTION REGULATIONS [Rev. 1/07] leave blank) 4 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 7 CM 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Insp tor of ires: By this application the undersigned gives notice of his or her intention to perform the ele rical work described below. q\t, Location(Street&Number) a , U,, R...,_ Owner or Tenant Telephone No. 3 Owner's Address `a Is this permit in conjunction th a b l Is permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building ��F�"/O— Utility Authorization No. Existing Service/CIO Amps /,._?e / 'Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ o.of Meters Number of Feeders and Ampacity (A)( . Ale A"C� } s-, _/d iv cAJ6r®P p ' iLocation and Nature of Proposed Electrical Work: t- / `�!7 v Completion of the following table rrr be waived by the Inspector of Wires. ',A i t. No.of Recessed Luminaires No.of Ceil:Sas No.of Total 0t p.(Paddle)Fans Transformers KVA _ '.:,t 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 INo.of Zones , No.of Switches No.of Gas Burners No.of Detection and Initiating Devices t No.of Ranges No.of Air Cond. Total ' Tons 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❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:' No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Estimated Value of Ele ica Work: � Attach additionaldetaily u municipald,or as required by the Inspector of Wires. (Whenrequired Y P policy.) Work to Start; "-- ...1 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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 CeP BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties Hof perjury,that the information on this application is true and complete. FIRM NAME: �pI! p'i"vi�J e, ew e. LIC.NO.: 4/S;12'C3 Licensee: �a 1-41 �"--n,40(�•.__ Signature LIC.NO.:C.ja' / (If applicable,enter'ex of r pt' ip the license � lue, �' Bus.Tel.No.: ) Address: 7 ; `ll y,2 "' 1- t Alt.Tel.No.: C j'�U 1' " *Per M.G.L.c. 147,s.57-61,se ity. ork requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By 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:$