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Home My WebLink AboutBLDE-22-004571 a . Commonwealth of Official Use Only 'E. 0Massachusetts Permit No. BLDE-22-004571 BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked (Rev.1/071 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:2/17/2022 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 elecmcal work described below. Location(Street&Number) 1r16 VENTURA WAY Owner or Tenant DIMONTE KEVIN Telephone No. Owner's Address 10 ADAMS RD,TOWNSEND,MA 01469 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Approp O ox) Purpose of Building Utility Authorization No. ///�//�� Existing Service Amps Volts Overhead ❑ Undgrd ❑ M New Service Amps Volts Overhead 0 Undgrd ❑ eS Number of Feeders and AmpacityLocation and Nature of Proposed Electrical Work: Replacement furnace.(HOUSE#16)Completion ofthe following tablerry/0,1/'" rofWires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of y Transformers No.of Luminaire Outlets No.of Hot Tubs Generators j �10) VA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emer.� Lii//ghtil grnd. grnd. Battery Un'Sfill 4 No.of Receptacle Outlets No.of Oil Burners FIRE M.eA I di No.of Switches No.of Gas Burners 1 Initi '-`es 7 Noics• No.of Ranges No.of Air Cond. Total No.of Ale g Devi,.- "'�a / / Ton. w me —cri , No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contai • " '*/ _ ,, Totals: Detection/Alerting, • ices No.of Dishwashers Space/Area Heating KW Local 0 Municipal •' • : : Connection No.of Dryers Heating Appliances KW Security Systems:' `tot,„:" 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 0 (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 hove 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:S50.00 1 RECEIVED 16 2022 nwaaf o<FYI la ' sense uraftd 1!t f^Official Use Only ^w_1g . c� 2� _ +�.: * 'fir arfinenl o� }' S' Permit No. �' l ', DEPARTMENT P u� ervued •. f i -Ba' e a-! RE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07I (leave 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 N) (PLEASE PRINT IN INK OR TYPE ALL INFORMATION! Date: -L NiiCity or Town of: YARMO By this application the undersignUTH To the Inspector of Wires; notice of his or her intention to perform the electrical work described below. location(Street&Number) 4 lac'rl j ll i 4'1 , G a 1"/ t -1'1 Nit I Owner or Tenant 10 Owner's Address / fl L Telephone No. �/�S�On �. S Is this permit in conjunction with a building permit? yes ElNO �. (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Uudgrd Ej No.of Meters _ New Service Amps / Volts Overhead N., Number of Feeders and Ampacity ❑ Undgrd El No.of Meters NI Location and Nature of Proposed Electrical Work: , n, v.} - Ursr Com letion o the ollowin table m be waived b the In ector o Wires. .. No.of Recessed Luminaires No.of Cell:Sus p.(Paddle)Fans O.° ota No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA t No.of Luminaires Swimming Pool ove n_ o mergency g ng ',..1'" No.of Receptacle Outlets rnd. nd• 0 Baotte Units No.of Oil Burners FIRE ALARMS No.of Zones ~` No.of Switches No.of Gas Burnerso.o etec on an i' No.of Ranges Initiatin Devices No.of Alr Cond. ota Tons No,of Alerting Devices No.of Waste Disposers eat ump um er cons o.o e oota ne Totals: No.of Dishwashers Detection/Alertin Devices Space/Area Heating KW Local 0 un pa No.of Dryers Heating Appliances KW ecu ty Connection ystemss: 0 °tiler o.o a er No.of Devices or E uivalent Heaters B ' °'° o.o SI ns Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromasaage Bathtubs No.of Motors Total HP a ecommun ca ons r ng: OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires. (When required by municipal policy.) Work to Start:_ t 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 0 BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,thq/the information on this application is true and complete FIRM NAME: �1 c 'IA e 1^� �d, r- (Dv,. G (1 Licensee: yl.i7 LIC.NO.:J e3v k)�' t•✓ (1 f V Signature f� —`---- (Ifaprlicable, exem t"in the lie number line.) LIC.NO.: Address: C7 6 C �: 1 y4,7 �� /1 Bus.Tel.No.�f� .y, �r� '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 Licensee does not have the liability insurance coverage normally required by law. Bymysignature �—" below,I hereby waive this requirement. I am the(check one p owner III owner's a•ent. Owner/Agent PERMIT FEE: $ . Signature Telephone No. 1 ,3. . i dY • • • • • •