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Home My WebLink AboutBLDE-22-004030 Commonwealth of y ' Official Use Only f� Massachusetts Permit No. BLDE-22-004030 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:1/21/2022 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 described below. Location(Street&Number) 97 CHIPPING GREEN CIR `-k Ie Owner or Tenant Telephone No. Owner's Address ROSIE'S TRUST, 1598 PLUMTREE RD, SPRINGFIELD, MA 01119 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 N . eters New Service Amps Volts Overhead 0 Undgrd ❑ ' T e Number of Feeders and Ampacity INI ' _. . Location and Nature of Proposed Electrical Work: Replacement HVAC. ` ry/^�fff 6 Completion of the following table ma " tie p� of Wires. No,of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of y /� `JI' Transformers ' r � `v 1 e."' - No.of Luminaire Outlets No.of Hot Tubs � Generators -,_�;/1 /1•IA No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergenc g `f, grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I N .of Z. 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 I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine 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 Ballasts Data Wiring: Siens No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 ofperjury,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 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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. I (PERMIT FEE:$50.00 I RECEIVED LN 2022 ° - sal o��I ac = �_% Official Use Only :: 'G DtF'ARI MENT �l apa m ntf vice9 Permit No. Z�-1 03�0^ _ c 0; ' _ , `' " "E PREVENTION REGULATIONS Occupancy cy and Fee Checked -_ • A DDI Ifs w TIt1►r �-�t-+ � eave blank All work to be performed in accordance with the Massachusetts Electrical od�t� LAB WORK (PLEASE PRINT IN INK OR TYPE ALL INFOC)>527 CMR l 2.Qo Cify or Town of: �T RMATION � �b /,� 3.. ires: By this application C yor the pnderfigned AOUTH ) To the Inspector 9 notice of his or her intention o perform the o tides abed below. • Location (Street&Number) 5 7 :: : ::: NA ;C11de �� rPeN Cil"C�Z a Telephone No. (S g (;v i Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building . ,� (Check Appropriate Box) Existing of Buie Utility Authorization No. Amps _Volts Overhead New Service ❑ Undgrd❑ No.of Meters _Amps / Volts --- Number of Feeders and Ampaci Overhead ElUnd rd ❑ No.of Meters g _ Location and Nature of Proposed Electrical Work: No.of Recessed Luminaires Completion o the oiawin- table m. be waived. the Ins,ector o Wires No.of CeiL-Susp,(Paddle)Fans No•of No. of Luminaire OutletsTransformers TOtal No.of Hot Tubs KVA No. of Luminaires Generators KVA Pool Above In- `o,o mergency . I ring No. of Receptacle Outlets prod, ❑ °rnd- Bat_t_e Units No.of Oil Burners No. of Switches ' a No,of Zones No.of Gas Burners `o.of Detection and No.of Ranges Iaitiatinp Devices No. of Air Cond No.of Alerting Devices No.of Waste Disposers Heat PumpTons Totals: umber Tons o,of elf-Contain. No.of Dishwashers Detection/Alertina Devices Space/Area Heating KW Local❑ Municipal No.of Dryers HeatingA Connection ❑ der No.of ater Appliances Security Systems:* Heaters KW No. o o.of No,of Devices or E.uivalent Si. s Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E.uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E.uivalent Estimated Value of Electrical Work rd e) Attach additional detail c fdesire d orc ys required by the Inspector of Wires.Work to Start: i r`� . (When required by municipal policy.) SURAN Inspections to be requested in accordance with MEC Rule 10,and upon completion. GE COVERAGE: Unless waived by the owner,no permit for the performance the licensee provides proof of liability insurance including"completed operation"coverage or its sub P rrnance of electrical work may issue unless undersigned certifies that such coverage is in force, and has exhibitedproof of same to the CHECK ONE: INSsubstantial equivalent, The URANCE,2 BOND permit issuing office. I cerizfy, under the pains an penalties o ❑ OTHER 0 (Specify:) FIRM NAME: One fperel{Y. that the information on this application is true and corrtplete e W G o rdl cs yl Licensee: �pt eyl LIC.NO.: 5 -2 30Y (If applicable enter "exempt"in the license number line.) Signature -�� Address: j LIC.NO.: J Per M.G.L. c. 147 s.57-61,security qu Bus.Tel.No.: �� 0 77 OWNER'S INSURANCE �+ ty"Fork requires Department of Public Safe Alt.TeL No.: OreWNER'S ' law. WAIVER: I am aware that the Licensee does not have the liability insurance c �_— T Owner/Agent By my signature below,I hereby waive this requirement I am ty prance coverage no al Signature the(check one 0 owner0 g normally Telephone No. owner's a enC PERMIT FFF. e