HomeMy WebLinkAboutBLDE-21-002793 Commonwealth of Official Use Only
i ; Massachusetts Permit No. BLDE-21-002793
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:11/17/2020
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice Of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 2 SQUANTO RD
Owner or Tenant GRIBBONS THOMAS R ' Telephone No.
Owner's Address C/O R BARBIERI/THOM R GRIBBONS,50 RICH ST,WORCESTER, MA 01602-1202
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check AppropBox)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd 0 r. . et w�
New Service Amps Volts Overhead 0 Undgrd 0 I r iVAW,
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring for heat pump. /40 triQ
Completion of the following table may be waived b, e I p.•..- Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of D
Transformers K
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ElNo.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 Number Tons KW No.of Self-Contained
Totals: 1 Detection/Alertine 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 Data Wiring:
Heaters Signs Ballasts 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: Eric W Drew
Licensee: Eric W Drew Signature LIC.NO.: 13118
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 103 MID TECH DR,UNIT A,W YARMOUTH MA 026732588 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
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
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�f pt /Jre ` rit.e.tv + ().c;pa:c\ and l l Checked BOARD OF FIRE PREVENTIO REGULATIONS_-i'r tet 1 (i�
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
>!:'al\irk to he F fornad tit a::o d t:Ice t,ith "e\ (s,acliti 1:1;:e ieal Cod:!(\IEC), 7('\1R '^00
(PLEASE PRINT IN:/\-KORTYP ::/Li_ 1.\F R.f, 7i :\) Date: t ( /6 .--c)
City or "Fo�%n of: (�y rA6 __-----
___ To the Inspector of fr fre.s:
By this application the o ndersigned giv notice of his or h r intention'` )Cr}on,:) the electrical tt or i
1 5 OGl ; d:::eribe.i :Eu�4.
Location(Street& Number) pr• �(.(�
Owner or Tenant 055c -- Telephone No.
O'sner's Address 5G..fe___ —�,-
Is this permit in conjunction with a building permit? Yes f ' No -pr - �-
(Cheek Appropriate Box)
Purpose of Building —`- Utility Authorization No.
- _- -
Existing Service - Amps i Volts Overhead n Lndgrd E No.of Meters --
New Service Amps Volts Overhead ; Lndgrd El No.of deters
Number of Feeders and Ampacit '_
Location and Nature ot-Proposed Electrical Work: i I I "Raj
tr.� ----'-_- --
We -- -
C(, pi�ni�,!i o"!Ile 'uiiox ivaL r n'. he i;c I t the r'tsi l:ur if/; ,.
n
No.of Recessed Luminaires No.of C'eil.-Stisp.(Paddle) E ans `So of Y Total-- ----- •Transformers k�':�
No. of Luminaire Outlets INo.of Hot 'Tubs Generators I{1':> >
1i -- Swimming Pool use -� fit- -; ii. of Lmerrenc� Lighting-` .-1
-No. of Luminaires _,
—_— ______..
g._.__ grnd. t grnd. Batttr�Units - _ {
No. or tieceptucic outlets 1u.of Oil Burners `.FIRE :UI.AR\15 0. of Yt1ut�'i .
No.of Switches No,of Gas Burners —~�— NtriirDetechon knd "
r- - -- -- - --._ Initiating Dcs�tce4•' 2
No. of Ranges itio.of Air Cond. Total `, • O .`
} Tons s. o.of Alerting De'ices m
\o.of Waste Disposers !Heat Pump 'Num-ber Tons I KW ;No.of Self-Contain cl=1-T_�— —`-`:':'4,
`` Totals: ; lDetet ion .>+tct tin cs s "1 ;,' >t'1
\u. of Dishwashers iS ue'Area Heating KW I Deal Niunictpal _. "";
! p` _ C'onnectto <)tl� `t
, i
`o. of Dt• ers iIicatinl;.#ppli:tnces kt\ -- ecurity c stems.*'` "� t. ;
{_ 10 of besiccs w lkyu►s.al `,
co. of Water_.______ kl` fin.of -- No. ofi `- - I!)ata Wiring,: --'
.__._._ Heaters _ - —, S Signs_ Ballasts
� __ _ 1 No.of Deices or Fes►�.ateift
No. Ii�dromassage Bathtubs I\o.of Motors Total — -- ;Ielecommunirar ons�(ring: -----1
__. j No.of Doit es or L'tiulsaItnt
-OTHER: - - --
1 siliva:Cd \;,..c o; Ille:tieiil \\c%k: ._-__._.___..___ _._. (\i h n req., e.i. l! by .our .:p.11 .1• e i .., /...
V,i ti. to Start Inspections to be requested in accordance V.ill"! \li t R :e ;'1 unit ))n a. t t,i:iiila.
INSURANCE COVERAGE Unless Mattel 1t the owner. no permit for the perfor..,am:e o e.e:.ric.i. t,ork mii\ iasiie uttii
the iitense.:pro,.ides proof of Iiahliu.A insurance including "completed operation co%erac of it? stibstant!al c:itllAaieut. 1 he
limier _nee certifies that such iiveriigc is in ao ee. and nits exhibited proof of stuns! to the per+ lit rss It tl/r ice
( !)I .KOM: (\SLR.\\C.'t ti()N.0 r Otiii..it• f (S,•: ,\ ) wKr. e_xK L (tQJj tl t--1 �/ f
I certift. under the pains and penalties of perjury,th I the information on this application is true and con:plele• C
FIRM NAME: {-1,(J 'erN 7 d-T/t C
Licensee: 1fr- -- led }„ly C_f,1J Signature / _ .-
(It app „,(hie, enter etetapt' v1 lnz�-!/�cen>e niiMbe+ 1lix., — '7 2 Bus.Tel.No.'1 f fl �7�a. -/a-3
Address: `'!_Ib Ir wd 1P Ck 1QV lid ,` >� 0A—Eig- 3�� l.3 Alt.Tel. No.:,5b73- t We)-7
e)-7"Per\i.G.t_. C. 147.s. 57-61,security work requires Department of Public Safety"S" License Lie. No. _
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does nor havr the liability insurance. coverage normally
required by law. Eat my signature below. I hereby waive this requirement. lam the(check one) owner ❑ owner's agent.
Owner-'Agent
Signature Telephone No. I PERMIT FEE: S
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