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Home My WebLink AboutBLDE-22-004801 Commonwealth of Official Use Only �� ` Massachusetts Permit No. BLDE-22-004801 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:2/28/2022 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) 1175 ROUTE 28 Owner or Tenant Bridgewater State College Telephone No. Owner's Address 1175 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ 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: Install temporary receptacles for asbestos removal 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. Ton l No.of Alerting Devices No.of Waste Disposers Heat Pump Number _ Tons KW No.of Self-Contained Totals: Detection/Alertine 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 Signs 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 Telephone No. PERMIT FEE: $80.00 � lrommoameaUh oi /aleac e f --- _._ -,� c� ORicial Cse O *' _ e arbnent o�c7 s' ' Permit No. _ (I;:.c*' P Yira era ce! „F BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Res.1'07) (-cave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in acccrdance with the Massachusetts Electrical Code(MEC).52'CMR 12.00 (PLEASE PR/VT IX INK OR f)'P ALL JVF TIO\) Date: City or Town of: a a a By this application the undersigned is e$notice of h-or her'mention:o perform theTo te /spector electr electrical.cork described below. Location(Street&Number) Qt jp S 56, (/ — Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes Ej Purpose of Building N0 (Check Appropriate Box) Utility Authorization No.______________ Existing Service__ Amps / Volts Overhead ❑ Undgrd❑ No.of Meters Ness Service Amps Volts Overhead Number of Feeders and Ampacity ❑ Undgrd❑ No,of deters Location and Nature of Proposed Electrical Work: y-e_ rt?ct)i2z, Comp/etir t;frhr lollonine table mat.Pr:aired ht Me/, oertor rl•It,-,,. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)pans o o Total No.of Luminaire Outlets Transformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above C n- o.o roergency Lighting grnd. rod. � Batters Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners iNo.of Detection and No.of RangesT. Initiating Devices No.of Air Cond. atal — Tans No.of Alerting Devices —fit Pump Number I Ton; KWNo.of Self-Contained No.of Waste Disposers Totals:[ - Detection/Alerting Devices No.of Dishwashers Space'Area Heating KW ^'Local❑Municipal Connection C Other No.of Dryers Heating Appliances Kit' ec,...____Local )vstems:�' No.of Water �o of No.of Devices or Equivalent Heaters KR No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No—of Motors Total HP Telecommunications NI(ring: — OTHER: No.of Devices or Equivalent Attach additional detail ifderired or a,rrq',ired Is,;he!wee for olll'irr,. Estimated Value of Electrical Work: (When required by municipal policy.. Work to Start: Inspections to be requested in accordance with MEC Rule IC.and upon completion. INSURANCE COVERAGE: Unless waived by the owner.no permit for the perfonnance of electrical work ma)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 woof of same to the permit issuing only. r CHECK o.E: INSt.RANCE75�BOND 0 OTHER ❑ (Specify:) LicL/wIC-fS(d rt(0 er�5/a a—I certify,under the pains and penalties ertuty,that the information on this application is true and complete.FIRM NAME:� C�) �J(S',� i Y L C \�� _ LIC.NO.: / Licensee: e L ,Li Signature a3� ///applwr.Ms.enter Teen+ t'i the licerue manhe,lines _ LIl NO.: 7 L Address: 103,� � � fit' ,w f' u,tA Bus.TeL No.:S0�y 77'6 D7.)3 'Per M.G.L.c.147.s.57-61.security work requires BeOanntettloVfYPublic SafetyAlt.Tel.No.: S1S 77 t(4 3Y OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hare the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check onej❑owner 0 owner's a Owner/Agent Signature Telephone No. I PERMIT FEE:S