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Home My WebLink AboutBLDE-22-002715 Commonwealth of Official Use Only E. ,a\ -' Massachusetts Permit No. BLDE-22-002715 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 1/10/2021 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) 41 NORTH MAIN ST O Owner or Tenant WHITE SALLY C Teleph 4& Owner's Address 41 NORTH MAIN ST, SOUTH YARMOUTH, MA 02664 `' Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec i s r 'a • 1 Purpose of Building Utility Authorization No. 0 Existing Service Amps Volts Overhead 0 Undgrd 0 No.of . 40 New Service Amps Volts Overhead 0 Undgrd 0 No.o ' > • + 1206 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. /4C 40° Completion of the following table may be ,i ,- •0. nspector 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 0 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:) 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 30,d1 RECEIVED rNOV 05 20211 //,� yy��i Cot> ea[fh o,tt/addac/<udelle Official Use Only ��ZZ- 271,E I.DING ULPARI-Nr�jNl �-'/ �i Permit No. —-�(J of a`Jur JAwicld �` BOARD OF FIRE PREVENTION REGULATIONS (Occuppancy and Fee Checked 14,, t ) (leave blank) ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.0 (PLEASE PRINT IN iNK OR TYPE ALL INFORMATION) Date: ///5" 2/ City or Town of: YARMOUTH To the Inspector of Wit es: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) V/ rr r-r)1 /^^Lj/ I') Owner or Tenant �Ca/& IA/12 j-r P_- Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd E No.of Meters Number of Feeders and Ampaclty / Location and Nature of Proposed Electrical Work: rely;rc� 6 U; le r- Completion of thefollowingtable may be waived by the b'totalor of Wires. U. No.of Recessed Luminaires No.of Ce6:Sosp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool ❑ In- ❑ No.01 Emergency Lighting 4Abovernd. gnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection and No.of Switches No.of Gas Burners No.Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste DisposersHeat Pump Number Tons KW _. No.of Self-Contained Totals: ..... . ...._... Detection/AlertlN t Devices No.of Dishwashers Space/Area Heating KW dal Municipal❑Connection ❑Other No.of Dryers Heating Appliances KW Security Syystems:• — No.of No.of Water KW No.of No.of Data WiringHeat : or Equivalent Signs Ballasts No.of Devices or Equivalent No.Rydromassage 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: 7 0 (When required by municipal policy.) Work to Start: /(/L//<) 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'] BOND ❑ OTHER ❑ (Specify:) I certify,under the ains an nalties of furyy,ithat the Information on this application is true and complete. FIRM NAME: •,1 l�1C)'✓ Ca 0 Cci 6 1-'`. t-f/' (}e Licensee:/M�� ii P • LIC.NO.: J� b 3 '>/!.C'V7/ �o�' 6 6^ Signature LIC.NO.: Address: ey0 4":"exempt",I' 'l,I) n,Ock°- e.l ' Bus.Tel.No.. Address: C2 Ct1 l f(J ,�� V; - �/1�'i`v Alt.Tel.No.: Per M.G.L.c.147,s.57-61,se urity work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: i am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$