HomeMy WebLinkAboutBLDE-23-15892 Al'C''
Commonwealth of Massachusetts o� Y�
Town of Yarmouth 3 ,, ,
tl 0 4v
ELECTRICAL PERMIT ,
Job Address: 491 HIGGINS CROWELL RD Unit:
Owner Name: NEW TESTMNT BAPT CHURCH OF WY
Owner's Address: 491 HIGGINS CROWELL RD Phone: Email:
Purpose of
Building Commercial Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15892
Existing Service Amps/Volts Overhead ❑ Underground❑ No.of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: Replacement of emergency lights.
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type:
No. Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No. Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool: In-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1 0 Level 2❑ Level 3❑ Rating:
•
Estimated Value of Electrical Work: $ 1 Work to Start: May 19, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ERIC W DREW License Number: 13118
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: W YARMOUTH, MA, 026732588 W YARMOUTH MA 026732588
Email: info@ewdrewelectrical.com Business Telephone: 508-778-0723
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.
INSURANCE:
(-(( ./ e
f"-- Commonwealth of Massachusetts Official Use Only
i * - P1 Permit No. 6 7-3—I S 42)1 v
al S Department of Fire Services
I'-- Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS IRev.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 NiM INFORMATION) Date: 6S' 1 --a 3
City or Town of: vf CAS tr 1 GCX Oln-. To the Inspector of Wires:
By this application the undersigned lives notice of his or her intentioner
to perform"� the electrical work described below.
Location(Street&Number) y9 I HAG\!S\(\S5 ( ]"UV \t-C3,
Owner or Tenant s}eve h{' J '- Uencc.A o]- Chwch_- Telephone No.1 -4 —$3bi]
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Qg f)La(0 ex S1"i(fit et-(LK UV t k, 1ty"
Completion of the followingtable may be waived by the Inspector of Wires.
otal
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers TKVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Pool Above In- No.of Emergency Lighting
No.of Luminaires Swimming grnd. gild. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.on Initiating on Dete and
Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
No.,if Waste Disposers Heat Pump Number Tons......._KW No.of Self-Contained
P Totals: • Detection/Alerting Devices
f - Municipal
Li.l m No of Dishwashers Space/Area Heating KW Local❑Connection ❑Other
�' C,1 i 1 HeatingAppliancesSecurity Systems:*
_ evil!of Dryers pp KW No.of Devices or Equivalent
��`c° �1lof of Water No.of No.of Data Wiring:
L11 Heaters KW Signs Ballasts No.of Devices or Equivalent
O .
Y 5 Telecommunications Wiring
QoF Hydromassage Bathtubs No.of Motors Total HP
W M I No.of Devices or Equivalent
1"�dER:
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: 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 thepermit issuing office.
CHECK ONE: INSURANCE 0 BOND OTHER ❑ (Specify:) 1.(p6i li wWlers cZ 0l f G-as- .3
I certify,under the pains and penalties of perjury,that the information on this appli n is true and complete.
FIRM NAME: �:±I,if /W / LIC.NO.: 131(3
Licensee: Signature/� LIC.NO.: 7
al applicable,eyyjjer"exen t' 'n e t e se v ber line.)'' p Bus.Tel.No.• 7 O 3
Address: `7.f I n P �v I jJ `Irt( Alt.Tel.No.:
*Security System Contractor License required for this wok;if applicable,enter the license number here:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent I PERMIT FEE:$
Signature Telephone No.
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