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Home My WebLink AboutBLDE-23-002168 Commonwealth of Official Use Only t , Massachusetts Permit No. BLDE-23-002168 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:10/24/2022 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) 14 LAVENDER LN Owner or Tenant GALKOWSKI MARK Telephone No. Owner's Address GRANTHAM LYNDA G, 14 LAVENDER LN,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: Wiring for furnace&heat pump. 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 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: 1 Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 ❑ 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 --, __ COuruueafth o • =? aalac use I Oftieial Use Only 1 _r cc�� ` l a(leparnf,,� s' Permit No. Z ere ervices 4; BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rsa [Rev. I IO7J (;cave blank 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 INFO,I t 1 OA) Date: —( 7-- � City or Town of: J'�-'(/J To the By this application thz undersigned yes noticf h e ois or her intention to perform he`electrical work described below. Location(Street&Number) Owner or Tenant n�' (r-� fi� i �Q-� Owner's Address iJ.5a4t,Q--.__ —`----- Telephone No. Is this permit in conjunction with a buildin►permit? �� g Yes C No Purpose of Building ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd E No.of Meters New Service __ Amps / Volts Overhead Number of Feeders and Ampacih' ❑ Undgrd C No.of Meters Location and Nature of Proposed Electrical Work: (,t j I ' _ o_c.,L_?,446ri:2__* Coin lotion of the ollowj,t table may be waived by the Ins ector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o•o ota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above n- : o.o Units cy ag ng No.of Receptacle Outletsr°d• ❑ rnd. ❑ Battery Units No.of OH Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etechon an No.of Ranges . 'No. Devices `o.of Air Co nd �`Tonsotal No.of Alerting Devices No.of Waste Disposers eat ump : umber ons Totals: etO.o e - ontaine No.of Dishwashers Detection/Alerting Devices Space/Area Heating KW Local Municipal No.of Dryers ❑ Connection ❑ Other r3' Heating Appliances KW Security Systems: o.o Pater KW 'o.o No.of Devices or Equit Heaters • o.o Sins Ballasts Data Wiring: No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP elecommuntcations Iring: No.of Devices or E uivalent OTHER: Estimated Value of Electrical Work: Attach addihorrat detail ifdesred or a.r required b» (When required by municipal policy.) 1 the Inspector of Wires. 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 mayissue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. undersigned certifies that such coverage is in force,and has exhibited proof of same to the permi •ssui $ ffic CHECK ONE: INSURANCE ►!� BOND q} q t� The I certify,under the pirins and p Ana 'es o e� OTHER Q (Specify:) (,��G/ (��Vt P l i(�� _��j ,.c�� FIRM NAME: to ew f 7 ry,that the information on this application is rue and complete. Licensee: LIC.N�.: j (lfapplicable,ent • rem Signature c� _ Address: p ",in errs rr rber line.) LIC.NO.: �} a Per M.G.L. c. 147,s. 57-61,security work requires epartment of Public SafeBus.Tel.No.: OWNER' Alt.Tel.No.: S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage �� required by �'"S"License: Lic. No. law. By my signature below,I hereby waive this requirement. I am the(check one) -__ Owner/Agented g normally Signature ---____._ owner 0 owner's...La ent. Telephone No. PERMIT FEE: ,�