BLDE--23-003005 . (/// ' Commonwealth of Official Use Only
'11_ ' / Massachusetts Permit No. BLDE-23-003005
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed
the
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Massachusetts Electrical Code (MEC),527 CMR 12.00
City or Town of: YARMOUTH Date To
the Inspector/1/2022
By this application the undersigned gives notice of his or her intention to perform the electrical work d scribed of Wires:
below.Location(Street&Number) 28 WEIR RD
Owner or Tenant TERESA NUNES
Owner's Address Telephone No.
Is this permit in conjunction with a building permit?
Purpose of Building Yes 0 No 0 (Check Appropriate Box)
Existing Service Am s Utility Authorization No.
P Volts Overhead 0 Undgrd 0 No.of Meters ,��
New Service Amps Volts //
Number of Feeders and Ampacity Overhead 0 Undgrd 0 No.of Meters
Location and Nature of Proposed Electrical Work: Replacement boiler
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 KVA
Generators KVA
No.of Luminaires SwimmingPool Above In-
grnd. ❑ grnd. ❑ No.of Emergency Lighting
No.of Receptacle Outlets Battery Units
No.of Oil Burners FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners 1
No.of Detection and
No.of Ranges Initiating Devices
No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers Tons
Heat Pump I Number I Tons 1 KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other:
No.of Dryers Connection
Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of
Heaters No.of Ballasts Data Wiring:
Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors
Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
Estimated Value of Electrical Work: Attach additional detail if desired,or as required by the Inspector of Wires.
Work to start: (When required by municipal policy.)
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:)
y
I certify,under the pains and penalties ofperjury,that the information on this applicationis 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 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
t 2-3( 6vA- 6 r 4wUt F7/iC ,T lift r
,Z` Commonwealth of Massachusetts Official Use Only.
'j Department of Fire Services Permit No. Z3 tGb�
_' BOARD OF FIRE PREVENTION R GULATIONS Occupancy and Fee Checked
[Rev.9%05] (leave 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 INFORMATION) Date: I(-- -a.
City or Town of: ?0,14001-(4To the Inspector of Wires:
By this application the undersigneds notice of his or her intention to perform t e electrica work described below.
Location(Street& Number) ag W 1 r- r_k ya(MO
Owner or Tenant Telephone No.-1'7 el V
Owner's Addres
c
Is this permit in conjunction with a building permit? Yes E No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead E Undgrd 0
No.of Meters
New Service Amps / Volts Overhead
❑ Undgrd ri No.of Meters
Number of Feeders and Ampacity - b ..- /
Location and Nature of Proposed Electrical Work: ~I
)7Iv- 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 r in- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units � _..._.1
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS N.o.of Zones
No.of Det ��n.._. �mm�No.of Gas Burners ection and
No.of Switches
Ranges Total
No.of Initiating Devices
No.of Air Cond. Tons No.of Alerting Devices
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 Municipal
- Connection ❑ Other
No.of Dryers Heating Appliances KW security 3`vstems;* "......
No.of Water 'tio.of No.of Devices or Equivalent
KW No.of
Heaters Data Wiring:
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 1J7res.
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 f.rce,and has exhibited proof of same to the rmit issuing
CHECK ONE: INSURANCE ❑ BOND L OTHER g office.
❑ y ap1i 'W t5Cfa� `"aG- a3
I certify,under the pains and penalties of perjury,that the information on this appli lMon is true and complete.
FIRM NAME: GO
Licensee: LIC.NO.: /
Signatur _ LIC.NO.: , 37
(I,applicable,e er "exem t",in e ice se u ber line) •
Address: Bus.Tel.No.: 0�
*Security System Contractor License required for this wo 7�
if applicable,enter the license number here.No.: it
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability
re below, I hereby waive this requirement. I am the(check one' owner
insurance coverage normally
required by law. By my signature
owner's a ent.
Signature
Telephone No. PERMIT FEE: $