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HomeMy WebLinkAboutBLDE-21-003617 Commonwealth of Official 17 Use Only " Massachusetts Permit No. BLDE-21-0036 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) 61 UNION ST Owner or Tenant MCCLINTOCK HENRY K Telephone No. Owner's Address MACKENZIE SARA J, 61 UNION ST,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appr 1 tr,Purpose of Building Utility Authorization No. ) • Z9 2.. ,/(`i ~Yr Existing Service Amps Volts Overhead 0 Undgrd 0 - '° t New Service AmpsVolts Overhead 0 Undgrd 0 'N ' •£ . a ; �i Number of Feeders and Ampacity " el ph;t Location and Nature of Proposed Electrical Work: Replacement furnace `� " Completion of the following table may be waived by the Inspectarires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of '- Total Transformers ''' KVA No.of Luminaire Outlets No.of Hot Tubs Generators . r''•.' 'N KVA No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emerge y ghting--` `"• grnd. grnd. Battery Units No.of Receptacle Outlets No"of Oil Burners FIRE ALA M . N lax-holes No"of Switches No.of Gas Burners 1 No.of Dete �6rn 1�Initiating Devi ( ©2 No.of Ranges No.of Air Cond. Total No.of Alerting Dev Tons emu �, r No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained ' Totals: Detection/Alertine Devices ,`` No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ '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 S. ,46....s., (Wcial 1_s,:Onk Commonwealth 4 rfizzsineL,dia -4- P; ,,-;,,-;iii,7- .. eparirnstit ot.gire .S..:ericei Occupanc and Fce Checked Ao BOARD OF FIRE PREVENTION REGULATIONS if Rex. I 07; ; ._-- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A!!nAork to b.:p:::-t'ori .:d in a,:eordance v.ith zl: Niassaelluez, 111 :ricil Cod,:(ME(.i. 5:17(*MR 12.00 (PLEASE PRINT IN INK OR T)PE."I. . INFORAIATI ). ) Date: Cit:!,. or Town of: _ WO To the Inspector.of If'ipes: 13.s this application the .inclersin..,-; ..4ives n)tice crf his or her i t mtion to pefform the electrical ‘A ork described belov... Location(Street& Number) n w a_ _____ Ossner or Tenant Telephone No. ---- - - Ossner's Address Is this permit in conjunction with a building permit? Yes [1 No Li (Check Appropriate Box) Purpose of Building Utility Authorization No. . Existing Service Amps , Volts Overhead 7 I.ndgrd Li No.of Meters Ness Service Amps ,' Vohs Overhead L.i Undgrd Li so.of Meters Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work:---tt—Airel , -----„ _ ________ „:,..,„•,,..,„iv,„b:,,in., b,, „,..,,,,,,,, ii,,,In,. :.,tar a/i -i N° of ,.:., -1,1<,0\xt...a _ I No.of Recessed Luminaires No.of Ceil.-Stisp.(Paddle) Fans Hr;insformers I -- No.of Luminaire Outlets No.of Hot Tubs iGenerators 1 Above ,:---1 In- f-- tNii. ot Lmerg,ency Lighting INo. of LuminairesISIvin "ing Pool grnd. ±-1 v,rnd. L.---i Batters Units I ..._.: - No._W.iii:cep i Ite+e-o-ut+e-ts 'N O.(ir on Bkl r tic rs 'FIRE ALARNIN No. of Zones 1 __________,i 76.of Detearron and I N o. of Ss%itches iNo.of Gas Burners Initiating Devices 1---- Total I - ,No. of Ranges •No.of Air Cond. N;() of Alerting Des ices Tons i• • ti, • Heat Pump I Number 'Tons i KW -No.of rs--:o.of Waste Disposers ' Totals: 1 I i IDetectionilerting,Dsices Ae _ — I--i c Local L-i-j Municipal r---1 No. of Dish hers ssas 1SpaceiArea Heating KW Connection I - -----------JR7e-u ritZcVSteni.s.7,---—------j No. of Dtiers ifleating.Appliances KW Li Other No.of Devices or Equisalent No.olWater No.of No. of 1 !Data Wiring: 1 KNN Heaters Signs Ballasts _ I . No.of Devices or Equivalent --, Thlecommunications Wiring: ! No. Hvdromassage Bathtubs 1No.of Motors Total HP i No.of Devices or Equivalent 1 , r _..... — 7 I OTH ER: , — yiak,id \' .;t of Lle,:zrical \1,ork: _ _ iVdhen requiredb rotini;:i7,11 ; i)iici.) 1.1..i i.to Start: inspections to(lc lequesecl in accordance 1k oh \II-.0 Ru[e :O. and u:,on comrktioa. INSURANCE COVERAGE: Unless v,-aiveLl by the ow nel.. no permit for the perforinance LC eleccal v,ork may issue unlcss the licensee pros ides proof of liabllity mN,rancc i T ieluding -completed operalion-,:i.n.,:rage ;.v.its substantial e.iui\alent. -1 he undersignd certifies that such ci)yerage i• in fotce and has eNhibiteci proof of same to the pen lit is,s4g pl.ti,ce • I ( t i 1-.Q.K ONE: INS(RANCE-. ?..,. t3()ND E.] oil-11.R [7-: (Specii.ri tk.)t.ii. c-61,.(9 (20.2_01 f t t---c--/ §'1---/.9S •0‘;'- I certify. under the pains.und penalties alcpi:rilu,ry,fit t the information on this application is true and complete. / FIRM NAME: (.---;14.) 1"- ez,k) ----V i c Licensee: w ::)(C...f.,(J Signature / - LIC. NO.: ell appliviVu. enk-r -evemp;lizLthc iiiroq..c nionbc; linc, r, Bus.Tel. No.:.r3 0 c's 77 a '7 0-3 Address: eti b Mo. 1€ CR la V ,k VA4 0 7.3 Alt.Tel. No.:165 37 "'a-7 *Per NI.G.L. e. i 47.s. 57-61,security work requires Department of Public Safety-S.' License: Lie. No. _ OWNER'S INSURANCE WAIVER: I am aware that the Licensee doe., 'tor havc the liability insurance coveratte normally required by law. By my sitznature below, I hereby waive this requirement. I am the i check one) Ei owner Laowner's aunt. Oss nerAgent I Signature Telephone No. 1 PERMIT FEE: S -------- --