HomeMy WebLinkAboutBLDE-23-002876 Commonwealth of Official Use Only
z - Massachusetts Permit No. BLDE-23-002876
)OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
ACATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00
.OR TYPE ALL INFORMATION) Date:11/23/2022
. Town(A: YARMOUTH To the Inspector of Wires:
.,the undersigned gives notice of his or her intention to perform the electrical work described below.
.eet&Number) 27 BAKERS PATH
Tenant BERTOCCI ANTHONY V Telephone No.
.,Address 27 BAKERS PATH, SOUTH YARMOUTH, MA 02664
.,permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
pose of Building Utility Authorization No.
/ fisting Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
vew Service Amps
Volts Overhead 0 Undgrd 0 No.of Met srs
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install generator /V
Completion ofthe l tab+e�gr '-1, h•,nspector of Wires.
�$� I'
tJ ► /14VA
Total
No.of Ceil:Susp.Paddle)FansTransformerdi
No.of Recessed Luminaires ICVA
No.of Luminaire Outlets
No.of Hot Tubs Generators O
veLi_ No.of Emergency - n
Apli
Abo
No.of Luminaires Swimming Pool grnd. 0 grnd. ❑ Battery Units
No.of Receptacle Outlets
No.of Oil Burners FIRE ALARMS INo.of Zo
No.of Detection and
No.of Switches No.of Gas Burners Initiatinc Devices
Total No.of Alerting Devices
No.of Ranges No.of Air Cond. Ton
Heat Pump I Number I Tons KW No.of Self-Contained
No.of Waste Disposers Totals: Detection/Alerting Devices
Local El Municipal ❑ Other:
No.of Dishwashers Space/Area Heating KW Connection
Security Systems:*
No.of Dryers Heating Appliances KW No.of Devices or Equivalent
HeatersN
No.of No.of Ballasts Data Wiring:
Water KW Siens 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.
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
"completed of liability insurance including 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.
OTHER 0 (Specify:)
CHECK ONE:INSURANCE 0 BOND 0
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
Signature
Licensee: Eric W Drew 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
owner liability insurance CI owner's coverage normally required by law.But my
signature below,I hereby waive this requirement.I am the(check one)
Owner/Agent 'PERMIT FEE: $50.00
Signature Telephone No.
I
i
official use Only --
Commonwealth of Massachusetts 23 2S
Permit No.
Department of Fire Services Occupancy and Fee Checked i
BOARD OF FIRE PREVENTION REGULATIONS ev.9 -j t:ea‘c ,lank)_
[ON FOR PERMIT TO PERFOcR`Mc`ELECTRICALrWORK
PPL[CA�t ( �_ —�—a---
.�il work to b_performed in aecerdance with the Massachusetts Date: ----"'--
LE.4SE PRINT 1•'�'1.�•h OR TIP ALL L\•FOR.1AT!O�I To the Inspector of Wires:City or Town of:
i3�:this application the undersigned.:ves notice of hi• or her intention��rfonn��electrical work described below.
Location(Street& Number) Telephone\o.
1 �IF
p�cner or Tenant _- 1► l
� ' tr �
Owner's Address _ 0•All No 0 (Check Appropriate Box)
1es ❑
Is this permit in conjunction with a building permit? Utility
Authorization\0._
Purpose of Building t ndgrd Ell of deters —
Existing Service Amps ---- r Volts Overhead El---•— No.of Meters
i Volts Overhead 0 Undgrd
tew Service Amps ----"•____
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ( re--
Conn lesion of the follo•;irr• table may be wafted by the Ins rotor of litres.
..o.o ota
KVA
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers of Hot Tubs Generators x`
No.
No.of Luminaire Outletsabove In- 0 . -0.o mergence g tog
Swimming Pool rod. �t'itd Battery units .
No.of Luminaires Oil Burners No.teMili of Zones
No.of Receptacle Outlets No.of •'o.o 1 etcction and ,
No.of Gas Burners Initiating Degices .
No.of Switchessotal
No.of Ranges
No.of Air Cond. .No. of Alerting Devices
Tons gyp,o e - ontatnc�
eat 'ump Number.... ()US �� Detection':dentin nee ices
No.of Waste Disposers Totals: 1 untctpai ❑ Other
No.of Dishwashers Space;Area Heating KW
Local 0 Connection
ecurtt�' Systems:
Appliances KWtio.of Devi cos or E•'ui`aloof
No.of Dryers o.o 'titero, o Data�;icing:
No.of Ballasts No.of Devices or E+uiv agent
KW Si n>
Heaters Telecommunications t icing:
No.Nydrontassage Bathtubs No.01'Motors Total HP^ No.of Deices or Equisalen
OTHER: o t required the inspector ,,,ire
1.
Attack crcfditio+cal dotal, i%cfeir cd. !
E
Estimated Value of Electrical Work:
(When required by municipal pvticy.+
Work to Start: Inspections to be requested in accordance with MEC Rule lit.and upon completion.
INSURANCE COVERAGE: Unless waived by the owner.
permit
toperation'.rformrage or ance of its electrical
lwk may issue
unless
the licensee provides ides that
f of liability insurances inf* .including"completed �c pE su comp �a� a3
cu•der.i�ncd certifies that such rovcragc is f.rcc. and has exhibited proof o��;10 the// run:t i>suin;�office.
BOND 1� OTHER ❑ (St
certi y ONE: the pains
andE ❑ p I 3
I rNrtifj•, under the parrs and penalties ofer ut •,that the information on this application is true anL Cc'complete.
FIRMNAME: w — LIC.NO.: 37? D Signaturg _
Licensee: Bus.Tel.No.: 7 yG,z
A dress:hle,a cr' "exenutl"ter e lee se t w rfier litre r Alt.Tel.No.'s'S 0 ber here: c
,Address: for
*Security System actoWAI License
am aware thatothe Licensee l does not hovelthe liabiliticense y insurance coverage nonnall)
OWNER'S INSURANCE
required by law. By m} signature below,t hereby waive this requirement. I am the(check�E�•,fI owner
FEL': $
owner's aecn
t.
Owner/Agent Telephone No.
Signature