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Home My WebLink AboutBLDE-23-001256 Commonwealth of Official Use Only ' ---; , Massachusetts Permit No. BLDE-23-001256 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:9/9/2022 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) 398 ROUTE 6A Owner or Tenant BETH KASTRITIS Telephone No. Owner's Address 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 boiler. 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. Total No.of Alerting Devices Tons 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 0 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:) Icertify,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 = - RECEIVED ,.• EP 0 8 2022 om ruoaa QQ`` yyy�jj ttf�of//laeeachiueafle flicial Use Only`Iif / nn . a 4 j :6i 6 N G D E PART M E N artmsnf o/..}ire�arvicse Permit No. ' ' Occupancy and Fee Checked ,f� u OF FIR PREVENTION REGULATIONS [Rev. 1/07] leave blank ik APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK � All work to be performed in accordance with the Massachusetts Electrical Code(IvC) 527 CMR 12.00 lV�� (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: C� City or Town of: vq 3 By this application the undersigned ive otM his OUTHintention to perform the electrical w Location(Street&Number) described below. Owner or Tenant F'-r q5 fr[ � `u�i Owner's Address Telephone No. ( \J� Is this permit in conjunction with a building permit? Yes ❑ No Purpose of Building ❑ (Check Appropriate Box) Utility Authorization No. `� I Existing Service Amps / Volts � Overhead CI Undgrd E No.of Meters ( New_ S___er / # vice AmpsVolts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: r u ' lf' Vi dV t• e s / Q Bit1a4-" Com,letion o the followin: table m be waived b the Ins,ector o fires, •l" No.of Recessed Luminaires ,' No.of Ceil:Susp.(Paddle)Fans o'o ota :1 No.of Luminaire Outlets Transformers KVA '�"a No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool • 'ove ❑ n- 'o.o mergency g mg ., •rnd. ! nd. ❑ Batte Units ;' No.of Receptacle Outlets No.of Oil Burners • .�- FIRE ALARMS No.of Zones h= No.of Switches No.of Gas Burners `o.o t etectton an No.of Ranges Initiatin. Devices No.of Air Cond. ota Tons No.of Alerting Devices No.of Waste Disposers 'eat 'ump `um er ons ' •• Totals: eo.t o e - onta ne No.of Dishwashers Detection/Alertin•_ Devices Space/Area Heating KW Local 'un ecti No.of Dryers Heating Appliances ecu„ty Connection ❑ �� `o.o "a er KW ty ystems: `o.o .o o No.of Devices or E i uivalent Heaters Data Wiring:Sins Ballasts No.of Dvices or E.uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecommun ca ons " ring: OTHER: No.of Devices or E.uivalent y�[� Estimated Value of Electrical Work: Attach additional detail ifdesired,or as required by the Inspector of Wires. Work to Start: �' (When required by municipal policy.) 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 3 BOND 0 OTHER I certify,under the pains Ai d penalties o perfu ,that the innformation on this application is true and complete. FIRM NAME: �!C O 3 Licensee: �1 �� S i� LIC.NO.: -1)/:tea (Ifanplicable,enter"exempt"in the license number line.) ne•) Signature --------- LIC.NO.:_ _ Address: Bus.Tel.No.:.� *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safe "S"License: G�j Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally Lic.No. required by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent ❑owner • owner's a,ent. PERMIT FEE:$ Signature Telephone No.