HomeMy WebLinkAboutBLDE-21-003820 Commonwealth of Official Use Only
04. ,I I Massachusetts Permit No. BLDE-21-003820
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'1/11/2021
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) 230 HIGGINS CROWELL RD
Owner or Tenant BOTELHO CHRISTOPHER J Telephone No.
Owner's Address 230 HIGGINS CROWELL ROAD,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 100 Amps Volts Overhead 0 Undgrd 0 o.
New Service 100 Amps Volts Overhead 0 Undgrd 0 M • `� y
Number of Feeders and Ampacity `�
Location and Nature of Proposed Electrical Work: Replace service. 649
Completion qf the following table may be wa Jae
I sj&) fires.
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) Fans
No.of
4ba
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators L1
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Li tin' ��
grnd. grad. Battery Units ,(�
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS N i of Z9nes
vj
No.of Switches No.of Gas Burners No.of Detecti grid 6 'Y Initiating Devic !./ 1 6
No.of Ranges No.of Air Cond. Tonal No.of Alerting Devi 0,�
Heat PumpNumber Tons ' KW No.of Self-Contained CQ O,
No.of Waste Disposers Totals: Detection/Alerting Devices �A)
No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:* N
No.of Devices or Equivalent
No.of Water hNN No.of No.of Data Wiring:
Heaters 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 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
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
1A2,j4/
— ---
•
A .ommnnuea !+o il°a:,ac�urls <,.ra-- ,ry t 38Zp Lrarnt `�'e :p e <
F' BOARD OF FIRE PREVENTION REGULATIONS ()•,dp' "and!``(!'c,A;:d
"
---
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
(PrE9SE/'k \ I
ti U! �Cil ,)�i
City or Town of arato � Date:___
far thisapphcutiu, !:..n dcr36_, u� "1 , 1 �/. I!- , If'we,:Location(Street R Number) `('`� e ,t.t.
O\\nerorTenant � O ---
---ems_ ..________________
Ow Address ._- telephone No.
OIs this permit ina conjunction with u building permit? i- - —
les
Purpose of Buildingis (Check.lpp_rop_ e Roc)
_—___. _- - ----1 out Authorization No - - -- ---
t:cisting Sersice/ Amps �p� Meters
' P � oYl/�olt. Overhead' _..._.-
/ptT Cndgrd� No.of>letrrs _� _—
Nesc Service 11/IVV Amps
/60— Vulss Overhead Undgrd I
Number of Feeders and:\ntpacit}. -- g No.of Meters _--
Location and Nature of Proposed Electrical Work:
s �r �e-( 61-- c se
o.of Recessed Luminaires
—________ 1No.of('eil-Susp.(Paddle)I-an>. ��' - osa
,llansformen -�-_--_---1
No.of Luminali a Outlets --- K \
___ No of Hot Tubs l ---
----T Generators Is\ \
4No_of Luminaires -- iSscunniing Puol-T Ure _ I n- ( +j�o.oTFmerrene\T7gh1rn
—� Ynd �-- $alters Units
l\ .:i R •pt.tcic Outlets -- \u.of Oil Burnrrs .
r .—_ --"-- Filet' ct..lRch , or/.ones
1No.of Switches 'so.of(,as Burners `.�o-Initi tcciion and-- —--
Ir----- --- initiating
No.of Ranges —_------1- — --- Total' �"' L'Devices
No.of Air Cond. Tons 'No.of Alerting De.ices--_
Nu.of\\aste DisposersHeat Pump \umber 11'nns K�1 No.of Self-Cool fined
i._ Totals: f Detection Alerting Di: ices No.of Dishwashers iS a ---1 _ ino Di:
L ..r.` _— p•ce":\rea Heating KW
!`Locol`_ Municipal Other Connection
No.of Ur}ers 4leating \pptia—mes hN-----'�ec ,Frg setnc:*.I- .'..-e^--- .._i
No,ufi t�it�r !No.of ---_.... No.of Deices or Funk i
Heaters K\\ -NIT of !Data Wiring:
-- -'
L..__.._. .j Signs Ballasts
�..\n.tl)dromassa�c Bathtubs ^_-- i\ .----- — No,of Devices os'±F.Liyikalens
t f• _ i. n.of Motors Total HP elccommunications.ulsal ----1-
1--- — --- --'----'-.--- — No.01 Uel1Cl5 Of�,�UI\'illelll
[OTHER:
c `i _- ,
c I \ \'r(-R t... .. ^I
'INSCR\\CFC(nFR:\GE \.i0,.,,: i` filg t ,, ,\,
. <.t t.. ps , p o' ii \ t t ! .t i :, t t,t - i ,uch crag,.i. ' , \hih t p c ,
e tit:( f)\l-. I\til:f:,\CL t3 )\U - O: SIR (>t .,.,K,e.r5c7e., 7, .c
f cerrij) under thepenalties of Jury.dent the information on Mix application Is rite and t omp!e�. /'`l
FIRM N\\IE. `t-4!
licensee:
icen t „ + -Signature _ I I( NO.:
Address A.(�Yytn `�n v. i `' K.
• J 73 Bus.Tel.Nu _ -�"Per MULL.c i} s:C 1,security work r a ir Departmentklt.I el No �7-c7}.3
OWNER'S R S INSURANCE \AI\E R ice s Public G` S [.!ia :e Li..\,,, `-[
require;',by lass. R� Ian aware that the Licensee doe,,;,,1 hn,r tha li,ibilitc ir.,,ira! c•
m'cia1anire below.I hereby wai\c this rrquiren;ont. I am be'rcF.cck one;`'ay.acrCO(crrgc nonnath-
Oss ner;agent
Signature owner' ac
Telephone No. PF_'R.VIT FEE:S