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Home My WebLink AboutBLDE-23-000516 Commonwealth of Official Use Only %.,,y' Massachusetts Permit No. BLDE-23-000516 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:8/2/2022 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) 11 DANBURY ST Owner or Tenant KAREN CHAMBERLAIN Telephone No. Owner's Address 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 water heater 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 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. 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 1 KW No.of No.of Ballasts Data Wiring: 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 0 S eci ( P fY:) 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 I E I �! Ll C vlitCt i( L 1`C. AUG O i E2 Commonwealth el Maddachiusetid Official Use Only BUILDING �' *' t �NT Apartment ofc'�ire n PcrmitNt2 Ij s Serviced Occupancy and Fee Checked t'S:; J BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] (cave blank 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: - 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) I ( , Owner or Tenant ; h C I i Imo, big f le, r Telephone No.1_1 L./ell' V w7/3 0—Owner's Address S G M'e__ Is this permit in conjunction with a building permit? Yes ❑ No,r (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ rd g ❑Und No.of Meters New Service Amps / Volts Overhead❑ Undgrd g 0 No.of Meters , Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: r' vj ; ► ' ', -..r 6 7 zit-rr C 0c .`,2s, Completion of the following.table mf be waived by the In ctor of Wires. ni No.of Recessed Luminaires No.of Cell.-Sasp.(Paddle)Fans No.of Total Transformers KVA r1 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 I No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones ti No.of Switches No.of Gas Burners No.of Setectlon and 11'` No.of Ranges Total Initiating Devices No.o}Mr Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump ' 1Number Tons KW No.of pelf-Contained Totals: ""` "" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal No.of Dryers Connection ❑ Otha• tY Heating Appliances KW Security Systems:f' 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 Eons Wiring: OTHER: No.of Devices or Equivalent Estimated Value of Electrical Work: 110 0Attach additional detail ifdesired,or as required by the Inspector of Wires. Work to Start:_ ]. (When required by municipal policy.) �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/fa BOND 0 OTHER I certify,under the ins an 0 (Specify:) FIRM NAME: en°Ines ofperjury,that the Information on this application is true and complete. �� Licensee: -�„ _t ry /- LIC.NO.: ,;,� U -�n i •^ Signature(lfapplicable enter. 'exempt"in the lic a line. LIC NO.: Address: -z e C' ✓+i /� H Bus.Tel No..,"! t n�7 *Per M.G.L.c. 147,s.57-61,security gVorlc requires Department of Public Safe "S"License: } � Alt.Tel.No.; OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n Lic.No. required by law. By my signature below,I hereby waive this requirement. I am the(check one ■ owner ■ owner's a•ent. Owner/Agent Y Signature Telephone No. PERMIT FEE:5 -/ —