BLDE-20-003518 Commonwealth of Official Use Only
/E�1� Massachusetts
Permit No. BLDE-20-003518
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 INMKOR TYPE ALL INFORMATION) Date:12/19/2019
City or Town of: YARMOUTH To the Inspector of Wirer:
By this application the undersigned gives notice of ors or net intention to perform use electrical work described below.
Location(Street&Number) 35 GLEASON AVE
Owner or Tenant SIMPSON ARLEEN F(EST OF) Telephone No.
Owner's Address 35 GLEASON AVE,WEST YARMOUTH,MA 02673
Is this permit hi conjunction with a building permit? Yes 0 No Cl (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: make misc.repairs to kitchen and basement area electric
Completion of the folltnvMg table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total
Transfornten KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires - Swimming Pool Above 0 lo- 0 No.of Emergency Lighting
grad. grad. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.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 Hat Pomp I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Munidpal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Deuces or Eauivaknt
No.of Water KW No.of No.of Data Wiring:
Heaters aliens Ballasts No ofDevices or Eanivaient
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Univalent
OTHER:
Attach additional detail(desired or es 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 thin application is trite and complete.
FIRM NAME: ERIC W DREW
Licensee: Eric W Drew Signature LIC.NO: 13118
(fapplicabk,enter"exempt"in the license number line.) Bus.TeL No.:
Address:103 MID TECH DR,UNIT A.W YARMOUTH MA 026732588 AIL 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:S50.00
•
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or Commonwealth of Official Use Only
• 'E Massachusetts Permit No. BLDE-20-003518
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:12/19/2019
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) 35 GLEASON AVE
Owner or Tenant SIMPSON ARLEEN F(EST OF) Telephone No.
Owner's Address 35 GLEASON AVE,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: make misc. repairs to kitchen and basement area electric
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 Ab ❑ In- ❑ No.of Emergency Lighting
griove d. grid. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1e01 Zones
No.of Switches No.of Gas Burners No.of Detection
Initiating Devices
No.of Ranges No.of Air Cond. Total n No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 0 r:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Eauivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Eauivalent
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 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
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