HomeMy WebLinkAboutBLDE-22-002307 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-002307
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:10/22/2021
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) 4 KATAMA WAY
Owner or Tenant WOLASZE ua! * ,. Y: IFE EST) Telephone No.
Owner's Address C ;= �; ',"'BOBCAT HILL LN,ASHLAND, MA 01721
Is this permit in conjunction with a m m ding permit? Yes 0 No 0 (Check Appropria
Purpose of Building Utility Authorization No. ! 4
Volts Overhead 0 Undgrd 0 ib : iters`�.,
Existing Service Amps � i .
New Service Amps Volts Overhead 0 Undgrd 0 No. tern,,«. .
Number of Feeders and Ampacity cl /`` C4
Location and Nature of Proposed Electrical Work: Replacement boiler. , `' s
Cle/// �p
Completion of the following table may be wOtvy�by is e o fires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) No.of I
Fans Transformers
��
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.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. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
Space/Area HeatingKW Local ❑ Municipal 0 Other:
No.of Dishwashers P Connection
HeatingAppliances KW Security Systems:*
No.of Dryers PP No.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
required bymunicipal policy.)
Estimated Value of Electrical Work: (Whenq P P y'
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 LIC.NO.: 13118
Licensee: Eric W Drew Signature
Bus.Tel.No.:
(If applicable,enter"exempt"in the license number line.) Alt.Tel.No.:
Address: 103 MID TECH DR,UNIT A,W YARMOUTH MA 026732588
*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. I PERMIT FEE: $50.00I
Commonweal o f/!/addachwetid Official Use Only
c-� �r Permit No. �2Z- 23 07
. •
:airw~r ! 2epartmeni o`...tiee Serviced
t, Occt�pnncy and Pee Checked
r "0 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1l07] (leave blank)
l 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 4LL INF RMATION) Date: JO --1 .D-I
City or Town of: uC ''%t(j v`r l To the Inspector of Wires:
By this application the undersigned Ives notice of his or her intentio t°perform the electrical work described below.
Location(Street&Number) - 1�J
Owner or Tenant Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Cheek Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd E No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: );CA k'/) /ler refidskyit,Liut
Completion of the following,table may be waived by the Inerector of Wires.
No.of Recessed Luminaires No.of Ceii.-Susp.(Paddle)Fans No.
KVA
No.of Luminaire Outsets No.of Hot Tubs Generators KVA
No.of Luminaires swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
g iprad. grnd. .Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.oTh on and
Initiaatingting Devices
No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices
No.of Waste Dis era "Heat'ump Xnmber Tons _ KW "No.of-Self-Contained
Pos Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ 'an :Item ❑ Other
No.of DryersHeating Appliances KW Sean-fly Systems:*
Sean-flyNo.:of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications 4Y s
Y g 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: 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 issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) ts) CO(Lei c,,,,0 0 r�q0'.-as--a a-
I certify,under the pains and penalties of perjury, at the information on this application is true and co
FIRM NAME: ttj b( P.P rl CG. . LIC.NO.: t ii S'A
Licensee: (rr-1 C, TyPij Signature �> LIC.NO.:a?ate L
(If applicable,enter'exempt"in lic_eyse umber line.) Bus.Tel.No.;56$77 0 I D-3
Address: Q'j D IVIk(�1 i e.U't W- a (01..w u Alt.Tel.No.:'%Dt 37 4G! 3T
*Per M.G.L.c. 147,s.57-61,security work requires> partment of Public Safety"S"License: Lic.No.
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)0 owner ❑owner's agent.
Owner/Agent PERMIT FEE: S
Signature Telephone No.