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Home My WebLink AboutBLDE-22-002714 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-002714 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: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) 76 LUMBERJACK TRAIL ,,N, ^ Owner or Tenant BECRELIS NICHOLAS N Telepho go. ,.s.'' Owner's Address BECRELIS ATHENA N, 76 LUMBERJACK TRAIL,WEST YARMOUTH, MA 02673 - " Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap?faopil to Boz), Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Metets `' r ` New Service Amps Volts Overhead 0 Undgrd 0 No.of eters Number of Feeders and Ampacity il,.-----70 Location and Nature of Proposed Electrical Work: Rewire heater. Completion of the following table may be waived byThe 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. Total 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 ❑ 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 s0. 10 RECEIVED NOV 5 ? ��s Commonwealth o� aeaachuaaffe Official Use Only N �l � G2=2� Z 7 (4) 'v ic,i cc��rr�� cc77 Serviced Permit No. �(Js/varfn+sn�o�}irs Jaruresa BUILDING utP'`.,� �.'` Occupancy and Fee Checked By __ -- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC,527 C R 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: i I /,j City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her inte tion to perform the electrical work described below. Location(Street&Number) "7,l / i1 t°r!bt'� A C% 7"rc�l II Owner or Tenant /�/j k b to c_ r e l i s Telephone No. Owner's Address I Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 1 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters i Number of Feeders and Ampacity i Location and Nature of Proposed Electrical Work: i-e w)re A'?t1�r 5 Completion of the following table may be waived by the Inspector of Wires. U. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA '=;t No.of Luminaire Outlets No.of Hot Tubs Generators KVA r.:a No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units 'w` No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices ° No.of Ranges No.of Air Cond. 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 Municipa ❑ ❑ other Connection No.of Dryers Heating Appliances KW Sec ri No o Systems:* 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 Elllectri al Work: 0 Or (Whenrequired by municipal policy.) Work to Start: / 1i4/Z I 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:) I certify,under the pains an penalties of perjury that the information on this application is true and complete. FIRM NAME: ,A./-i I LIC.NO.: .- tom, 3 U 13 Licensee: j.•11 ei 1 a i- *s, Signature `' LIC.NO.: (If applicable,cotter"exempt"in the license n nber line.) /'� _ J Bus.Tel.No.: 5 tJ gh°°4.2 6 77 Address: 60 0easartdJ1 A,/�, J 0i4i [/e �11 t Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,sec work 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. ( PERMIT FEE:$ I