Loading...
HomeMy WebLinkAboutBLDE-22-005908 .............. Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-005908 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:4/14/2022 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) 43 WEBSTER RD Owner or Tenant WILBER EBURN Teleph a N . Owner's Address Is this permit in conjunction with a building permit? Yes 0 No 0 ec r ) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 4> e New Service Amps Volts Overhead 0 Undgrd 0 No. 4, ',`b‘ Number of Feeders and Ampacity w Location and Nature of Proposed Electrical Work: RUN LOW VOLTAGE WIRING FOR MAKE UP AIR UNIT WITH ,Lite Completion of the following table mil? e iv b Q nspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of r 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 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons K\\ No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal p 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Gary L Gordon Licensee: Gary L Gordon Signature LIC.NO.: 15290 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:37 BILLINGSGATE DR, DENNIS MA 026382234 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 , . 4RECEIVED c -.-cli\---:-7--------- Con:n:onwsa o� ajPR14 2022 Official Use Only -ti--=/fM 1Jarpartmenf al5. Stmts. 1 NG DEPARTM ��.L-C' /� C� °�- , 1-- I.\ J'tNo. ancy and Fee CheckeBOARD OF FIRE PREVENTION REGULATIONS 1 •ev. I/•07] (leave blank) d DDI ff A`Trn►r r�r, mr-.-...._ -- --- — • •"'• ' "�- -�a�1� iv rcrrL V tLtl, I kIUAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 12.a0 .. (PLEASE PRINT IN INK OR TYPE ALL INFORlvfATI0.N) Date: NN City or Town of: YARVIOUTH t�' To the Inspe for of ires: By this application the ltndersigned gives notice of his or h inten n to perform ' e-ectrical work described below. Location (Street&Number) _j �b�re Owner or Tenant G!//z-g�,Q 68(� 1 Telephone No. Owner's Address Is this permit in conjunctio with building permit? Yes J�`� No�i ri�r� ❑ (Check Appropriate Box) Purpose of Building )_ Utility Authorization No. Existing Service /)O Amps ©r/J Volts Overhead ��A N7 Undgrd❑ No. of Meters New Service Amps / Volts Overhead❑ Undgrd g No.of Meters Number of Feeders and Ampacity AA J Zert,J Ua#6j.o` L.J7 it_ the-- use Location and Nature of Proposed Electrical Work: 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 1Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above In- No.01 Emergency Lighting grnd. ❑ arnd. ❑ Battery Units No. of Receptacle Outlets INo.of Oil Burners FIRE ALARMS 1No.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Initiating Devices No. of Ranges I l Tota No.of Alerting Devices Na of Air Cond. of Waste Disposers Heat Pump I Number Tons H KW No.of Self-Contained Totals: Detection/Alerting Devices X- No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* — % No.of Water No. of No.of Devices or Equivalent _ Heaters KW No. of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent _ _/Attach additional detail if desired or as required by the Inspector of Wires- Estimated Value of El trio 1 Work (When required by municipal policy.) Work to Start: /V Inspections to be requested in accordance with MEC Rule 10,and upon completion. Z) INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work mayissue the licensee provides proof of liability insurance including The undersigned certifies that such cover e is in force, and has exhibited proofr of same to the permit coverage or its substantial g office. uivalent, The CHECK ONE: INSURANCE X BOND ❑ OTHER ify:) I certify, under the pains and penalties operjury, that the informationi on this application is true and complete, FIRM NAME: � �f� �O wear,' /� Licensee: �y� � � '/ �li LIC.NO.:/9 9Q • (If applicable, enter " mpt" • the license number • .) `Signature LIC.NO. Address: eiZit, 10 J /J •• Bus.Tel.No.. 7p61_672yey j 'Per M.G.L. c. 147, s_57-61 sec work requires Departrnent of Pu tc Safe Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I a aware that the Licensee does not have the liability insurance nce coverage n — S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner o 7 Owner/Agent1.11 ❑ wner's a end Signature Telephone No. PERMIT FEE: S