HomeMy WebLinkAboutBLDE-21-002566 Commonwealth of Official Use Only
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Permit No. BLDE-21-002566
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:11/5/2020
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) 52 PARK AVE
Owner or Tenant LANCTOT JOSEPH E EST OF Telephone N .
Owner's Address CIO ZUIDEMA PETER&PAUL, 208 SOUTH IRVING ST,ARLINGTON,VA 22 `'- 28
•y"`.,
Is this permit in conjunction with a building permit? Yes 0 No 0 (r o
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 i i ice' gliti
U
New Service Amps Volts Overhead 0 Undgrd 0 No of Q M
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacement HVAC&change sub panel. 4 ,0
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- 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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
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 0 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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tzeff6 Official
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Occupancy and Fee Checked —•�
• ,,"��' BOARD OF FIRE PREVENTION REGULATIONS iRev. 1 (>�'
APPLICATION FOR PERMIT TO PERFORM-______'___t��._,eblank) __ _ ___._____,
All'A ark to he pi:"tljmed in dco d`ir. f\FORM Code WORK
'ce IA the Massachusetts I:j-+:�ricaj C octe{\ff�C'(PI-ELSE iSI PRINT 1_�'INK. OR TYPE;'�_L L FOR'IA"IU.;> } 527(� �R �'.t�'a
CityDate:
or Town of: Toy this --- -- --- - _ __ __.
application the undersigned }� } • - _ the Itispectot-qi')f Wires:
s:
nonce of Ills or her intention Co f !Location (Street \utnber) a� i%Gear ll th/e cictricaj work described below.
________----
Owner or Tenant ------Y t... �-�-�i._S,_.-__����_�t / _
Owner's Address - _ I'eiePhane No.
Is this permit in conjunction with a buifdiit ____• ____
g permit? Yes r i No Ej (Cheek Appropriate Box)
Purpose of Building
Utility Authorization No.Existing Service Amps __Volts ""'"""`"____
-- __ Overhead 1 E ndgrd ' No.of Nleters
___ Service _ AmpsVolts --
Overhead `�
Number of Feeders and :lmpacit} - Undgrd \o. of Meters ____._
AC
Location and \ature of Proposed Electrical Work':;: _. 2 V C 1"`_`-< 5"l�
. ____ -ec� _ —_ _
•
-- -_ e... , 't .ahlrn ,, •:;tctl h;_fi!< !r
No.of Recessed Luminaires No.of Ceii,-Susp.(Paddle)Fans ' °t'cr., c, t
o.o ota
:�o. of Luminajre Outlets __ �� ____ __ f'I'ransf'ormer, Ka"
No.of Hot Tubs Generators _ K\ A
No. of Luminaires __ # a' e ""in." �r�o;a
__ _ -ti_,._ Swimming Pool Merl enT.3" titiitg-'�__-__..
\u. of 12�cej�tucic Outlets - --.-- - - rnd. �� grnd. jgattery units
___,_ ��_____�o.of Oil Burners FIRE_ ALARMS \t,. of Zones
No. ot'titi+Itches No,of E;as Burners +--_— �o p titer tioitan
No. of Ranges ! : Initiatin Devices
{ \o.of Air Cond. ionsTota _ q
�� - Heat Pump Tons i:�o.of Alerting Devices
i1o.of Waste Disposers P' umber Tt'Iy+ii
Totals: � 'ao.of 'et -Contained �` -'"'•-"
No. of Dishwashers - - _ Dew t_ Cction ._lertt"n Devices
���� ,Space/Area Cleating Kea LDeal❑ eipa r--. .�er - -
\o. of I)r}ers Connection } Oher
Cleating Appliances _-__c""ca`Lt.1"" it .21 _, : �.
Kti�' ,Security ,vim, steins: ,
o.o'er-f'1'�'er "'----- -------------. !o.of Devices or k:c uivaient �'
... Heaters KE3' iNo.o \o. a? - —��r - ng: j
-- -'----- signs Ballasts (Data 1a'iring:
No. H}drornassa c Bathtubs l No.of Devices or Et uivalent
- g �o.of lgoriars elecom Devices
e arsons it n "}
Total HP
)THf:R "� _ �` - ___ _.i_.�O.of Der is s or Etjlt ct' tint
j sCii.?a iil \ tit:c ofElectrical \\ilk: r u'r'rt a-a Yai 1-.c r T . I r -
t a r. l...'..d l�
,i he requiredtry ;rc, r �,;ci"nr::; ;i'rr,.
work�to Start: .- - - 11t 1! > 1 phis,�•j
Inspections to ne revue :ed :n accordance s4 itb \Qh�r Rule 10. and t.) In completion.
I\Sl,"RaNCI: C(1'�'E}2:aGE: t 11e5s ,;a„ � ,
�G s the ov,n '. no permit for r o•e performance . ' r tssu
fj c licensee pros ides prciil.`Ot liability ' O?�crcCrtcat s10'k Mal rs" 'SSWunless
insurance' including -completed ")perarion Co\ rr r t. e undersigned certifies that such ,) irii4?c is :i? force, and has c l L it til brit!?tti i equivalent. i he( }it_C�Fti ONE: t ♦SI�K�vc'L: � �..� exhibited proof of a,r.,, to:he,c!'r} t r '+
I certifi under the pains and penalties o . r tmacei n on LA.)�1Up c ?�t and
i nt t"=I �3/fir /�
FIRM 4 aME: f p'r�rrry, tlr r the infirrmaticrn this application is true arrrf cunrplete. 1" 111
I reensee
t� �c 1 j LIC. NO.: .3!!j tt�p'r:rr�1�, elttel Signature
�»ti,E I cF.t.c r urtt>�, l r, I.IC. \E);2_La to
address .�j Ip i ,1.r i/ � 3�I�;
*PerAdd ss:M.O.L.c. I.3'. . s , Bus.'Tel. No.; 0 ?7 c}3
6:,security work requires Department of Public ` - Alt. Tel. No.: 0 3 OWNER'S INSURANCE WAI'1'FR. I am aware thatSafety/ia - the liabili:
the Licensee does rot have liability insurancetio.
Oregtliecd by law. 'fl, my signature below. I hereby waive this requirement. I am the(check one)'lowlier
Osvneed.4 co- (.;-e er's aijy
Signaturencr � owner's af;err.
PERMIT FEE: