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Home My WebLink AboutBLDE-22-002716 . a• Commonwealth of Official Use Only A` ! Massachusetts Permit No. BLDE-22-002716 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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•11/10/2021 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) 43 WAMPANOAG RD Owner or Tenant LIBRIO JO ANN Telephone No. Owner's Address 43 W NORMANDY DR,W HARTFORD, CT 06107-1444 Is this permit in conjunction with a building permit? Yes ❑ 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 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. 1 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 ❑ 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 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Matthew Gordon Signature LIC.NO.: 55830 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:22 Station Avenue,South Yarmouth Ma 02664 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 - RE 'CE1VED �dr NOV 05 24100!! y�j Commonwealth oI///aatachuastte Official Use Only BUILDING uc : ,.. lillE By -_- -- ---- C1 .0`.„.�-, - 21spartmenf of girt,Struicsa Permit No ��•/ 1j� I i" a'(A`71 Ocupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.c l/07] (leave blank) ,, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CM 12. 0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / 1 /5 �City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfo the electrical work described below. Location(Street&Number) 5 W 41 NA r 10,0 1 K or,) C Owner or Tenant r JGl^iiC f;6r,s Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Ell (Check Appropriate Box) Purpose of Building A o&I f-e Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd g ❑ Na.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 0Wrt 1 e--F A r �� I.--keerr,- 1 in t, WI U Completion of the followinktable mDI be waived by the Inspector of Wires. 0 No.of Recessed Luminaires No.of Ceil:Sasp.(Paddle)Fans No.or Total Transformers r.' ;t No.of Luminaire Outlets No.of Hot TubsA - c.:-.iGenerators KVA No.of Luminaires Swimming Pool Above gr ❑ In- No.of Emergency Lighting ad. 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 No.oiRan es Total Initiating Devices g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained Totals:I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipa Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El ctrical Work: /30 Work to Start: / � (When required by municipal policy.) �/2 1 Inspections 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 BOND 0 OTHER 0 (Specify:) 1 certify,under the pains and e aloes ofperju thatiu rhe Information on this application is true and complete. FIRM NAME: � , ' o/ Licensee: �_y�ke Jri LIC.NO.: �P t l W eio sr Signature LIC.NO.: (Ifapplicable,enter"exempt"in the ligense nu ber line.) Address: f e) t U �,i /"yt/ �l�- Yl f�/' j'7E?l!i 3Bus.Tel.No.• 6`c)77 *Per M.G.L.c. 147,s.57-61,sec work requires Department of Public Safety"S"License: Alt.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 Owner/Agent ■ owner ■ owner's a:ent. Signature Telephone No. PERMIT FEE:$