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Home My WebLink AboutBLDE-22-003030 .� Commonwealth of Official Use Only L. „t Massachusetts Permit No. BLDE-22-003030 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:11/24/2021 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) 20 FORSYTH AVE .:,j Owner or Tenant Darren McGinn Telephone No. Owner's Address 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: 2nd floor apartment .,_ 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- ❑ 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 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 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 Ballasts Data Wiring: Heaters Siens 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 my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature 11 Telephone No. PERMIT FEE: $100.00 ��1�(�, ( ( t 7/2?� i c(L.-U ( t't) z/I LC�'Z2 1`C(- �- 51 y f z2 (/ 4 - zr � 1 �� (Caen p °mmonweatth oiaac�iuse � Official Use Only -- a ry, Permit No. t apartment ol ire�ervite9 �2 �� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ ! ® w PPLICATION FORtRev. U07] leave blank) 1 �--Lid PERMIT TO PERFORM ELECTRICAL WORK > o ,_ All work to be performed in acccrdance with the Massachusetts Electrical Code(MEC),527 CMR,12.0 rM O R I `" ( SE PRINT IN INK OR TYPEo0 c�•' ALL IN RIVIATION) Date:LLJ c\t ± City or Town of: To the o Bz tl1±°:r ::s application the undersigned fives notice of his or her intention to perform the electrical nspector�o Wires:~�w. t Z umb k described below.nt C tnvl ()wn 's Address ` Telephone No. �� Is this permit in conjunction with a building permit? Yes `�__ Purpose of Building No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters New-----Service Amps I Volts — Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _ubtre,......a 00 Con: tenon ojthe olloxin tablernae Le;vaivedbti the/tzsxetorol Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans °•o � ota No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators K%A No.of Luminaires Swimming Pool -wai En- No.of>L;ntergency yg tng No.of Rece tacle CYutlets rnd. rnd. ❑ Battery Units P Oil Burners FIRE ALARMS Na.of Zones No.of Switches No.of Gas Burners No.of Detection an No.of RangesInitiating D2 evices No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump 'Number,_ Tons.._._. KW........ No.of Sel - ontatned Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local un,________Connection No.of Dryers Connection ❑ Other Heating Appliances K��, ecu t}•Systems: — No.o Ater No.of bevices or Equivalent Heaters KW o•0 1 0.o� Data Wiring: Si ns Ballasts No.of Devices or E uivalent No.Hy�dromassage Bathtubs No.of Motors TotFt!HP �Telecomraun aiions irmg: OTHER:rNo.of Devices or Equivalent Attach additional detail it desired. or as required by the Inspector of'!tiires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing officquivalent. The CHECK ONE: INSURANCE BOND 0 OTHER I certify,under the pains and penalties operjury,that the information}on this:) application s trueue and complete. FIRM NAME: f Licensee: --� LIC.NO.: ^�� afapplicable,enter "event t"i the license number line.) Signature Address: LIC.NO.; 7d3 L 13us.Tel.No.: 773 *Per M.G.L. c. 147,s.57-61,security work requires De arum t of Public Safety"S•°License: Lic. No. Alt.Tel.No.:__ _7 �e y OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage no required by law, By my signature below, I hereby waive this requirement. I am the(check one) owner Owner/Agent g normally Signature owner's a ant. Telephone No. PERMIT FEE: $