BLDE-21-006056 '` t Commonwealth of Official Use Only
i. A, ' Massachusetts Permit No. BLDE-21-006056
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:4/21/2021
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) 26 SHAKER HOUSE RD 'I" 0/ 5 1 ,, 9"? i J 6
Owner or Tenant Bruce Clark
Owner's Address 26 SHAKER HOUSE ROAD,YARMOUTH PORT, MA 02675 Telephone No."
Is this permit in conjunction with a building permit?
Yes 0 No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0
New Service Undgrd 0 No.of Meters
Amps Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Boiler&water heater
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
Transformers Total
No.of Luminaire Outlets KVA
No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners
FIRE ALARMS I 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
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal
Connection 0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water 1 KW No.of No.of Devices or Equivalent
Heaters No.of Data Wirin
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
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
I certify,under the pains andpenalties o (Specify:)
f perjury,that the information on this application is true and complete.
FIRM NAME: Eric W Drew
Licensee: Eric W Drew
Signature Tel. NO.: 13118
(If applicable,enter"exempt"in the license number line.)
Address: 103 MID TECH DR,UNIT A,W YARMOUTH MA 026732588 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.:
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 ❑ owner's agent.
Owner/Agent
Signature Telephone No.
I PERMIT FEE:$50.00 I
-� '.` Commonwealth of Massachusetts ; Official Use Only 7
. _ 2(-lee c(o
"� ' g Permit No.
1 . Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS i[Rev. 9;'05] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All,work to he performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 17.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: - 1 b >- 1
City or Town of: a 5J(bL To the Inspector of Wires:
By this application the undersigned Ives notice of his or her'1wntion to perfori i the electric I wo-k described below.
Location(Street&Number) a 6 S t� ' fie ')` �, , `J C,Owner or Tenant �j`/- r Telephone No. '7Z(
U 4 p 367- �r
Owner's Address -5A_,,yit....2__
Is this permit in conjunction with a building permit? Yes ! No I I (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 7 Undgrd — No.of Meters
—
New Service Amps / Volts Overhead Undgrd P No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: l r. i0 (- Vas' *- Y\
Completion of the/i lloa ing table may he waived b. the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans Transfor
mersTot KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergerie7ti kiting
No.of Luminaires Swimming Pool grnd. ❑ rnd. ❑ Battery Units
No. of Receptacle Outlets No.of Oil Burners I FIRE ALARMS No.of Zones
No. of Switches No.of Gas Burners No.of Detection and
initiating Devices
Total ,
No.of Ranges No.of Air Cond. Tons I No.of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers - -
Totals: ;Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW t Local Municipal
P ❑ Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
NO. of Water No.of No.of No.of Devices or Equivalent
KWHeaters Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
w No.of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required bl,the Inspector of If Tres.
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
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuingr office.
CHECK ONE: INSURANCI BOND El OTHER ❑ (Specify:) `AJ'C{�5 C.G�(tt�z1 r v,,, % g1 a. 1' -1
I certify,under the pains and penalties of perjury, that the information on this application t.•true and cot lete.
FIRM NAME: .\ Z) (.6 ./ LIC.NO.: I3( i 4-
Licensee: "( `�e U_) Signature/2�/'" ' LIC.NO.: c}7)-357
lif applicable ant • " mitt,"in th lir. Timber line.) ``/� r� Bus.Tel.No.:.5 7 TO 37 d�
Address: L(�j rU jd \C7_ �}f� w r aL 1�'l'( lS Alt.Tel, No.: S7a7 �-7
*Security System Contractor License require for this work; i applicable,enter the license number here:
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. PERMIT FEE: $