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Home My WebLink AboutBLDE-21-003615 �' � Commonwealth of Official Use Only 1 ', Massachusetts Permit No. BLDE-21-003615 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:12/31/2020 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) 17 TEMPLETON PL Owner or Tenant Hetu Telephone No. Owner's Address 17 TEMPLETON PL,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes 0 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 HVAC. 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 Emergenc i irtg grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALA i1o.,6jlenes No.of Dete i p and. `�'�' No.of Switches No.of Gas Burners 1 Q Initiating Devicys 1 No.of Ranges No.of Air Cond. 1 Total No.of Alerting D'huices �4/ 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 ❑ Municipal 0 Other: Connection 'o No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: 3._ 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 ❑ (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 &Z,S) 71, vim- i Cttmsoawea64 el/lf umeiaueOfficial Use Only .t Permit No. — Cc� N. .25 o/ &rvkes *�I . BOARDOccupancy and Fee Checked OF FIRE PREVENTION REGULATIONS (Rev. 1/07) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All woth to be performed In accordance with the Massachusetts Electrical Code(MEC),527 CMR i�Q (PLEASE PRINT IN INK OR TYPE ALL 1NF TION) Date: f a- -�- �"U City or Town of: (,/ j�,p To the inspector of Wires: By this application the undersigned vea ponce o his or her Intention to pethe_.0 electrical work described below, Location(Street do Number) 7 in.IT l(�( l , Owner or Tenant 1 1.Q-k--(1 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 tin Auxtu _ Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Anspacity Location and Nature of Proposed Electrical Work: t i. C I/61QQ_tAC._.— Cootoifqion i f the fallimlnitt4le otp be waived by the Ingp I r cif Wires. No.of Recessed Luminaires No.of Ctdl.•heq►.(Peddle)Fans O.of T _ Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Poe! e ❑ mod. ❑ potion 7Y JAW* ong No.at Roceptoolls Owlets Na.-ef-ERt-flarncrs FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners O.Xthig ]jA an tivlfot No.of Ranges No.of Air Cond. Tel No.of Alerting Devices No.of Waste Disposers Ke r=, . 114.116111419141 ....,... .......... 'No of Seif"Con i No.of Dishwashers Space/Area Beating KW Local 0 "�''t; 0 Other No.of Dryers Heating Appliances KW $eehrity S. 'rf'1 ': No.or waterNo•of ► . or Equivalent HeatersKW Na.of Ballasts Date Wiring: y, Sim Ballasts N=. , .t a Ai = • ! valent No.Hydronnassage Bathtubs No.of Motors Total HP ,. r Ot Or.1 or is ivi t OTHER: Attach additional detail(f desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 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 DI undersigned certifies that such rage is in force,and has exhibited proof of same to the pe t isau' g Mee. CHECK ONE: INSURANCE BOND 0 OTHER 0 (specify;)1,t e.i15 C L1K 1 aQ,Dl 1` ea°ye Ey 1 cert4.,under the eyed R1 ►y', the iti orwtuaton on this p �/ `o FIRM NAME: PPK�t►n true and aa�errple/e. `' ' "C.M.L "YI C LIC.NO.: I b Licensee: V L Slgnatare (U applicable, ter i'j jb s nnamberaline.,) LIC. o. Address: (41 D Y IA) r' t/,t ��7 Bus.Tel.No.: 4 W is .► 1 `Per M.O.L.c. 147,s,57.61,security work requ vJt Y 1 Alt.Tel.No.: ✓ , ,�'�j��(" �.�' �t of Public Safety.,S„Licenser Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee doss not have the liability insurance coverage normally Owner/Agent by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner.agent. SignatuCe Telephone No. J PERMIT FEE: $