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Home My WebLink AboutBLDE-22-005784 Commonwealth of Official Use Only O Massachusetts Permit No. BLDE-22-005784 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 Codc (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:4/11/2022 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) 61 SHAKER HOUSE RD Owner or Tenant Michael Podiot Telephone No. Owner's Address 61 SHAKER HOUSE RD,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Ghee iveri 9 Purpose of Building Utility Authorization No. ,_w ti / 5` Existing Service Amps Volts Overhead 0 Undgrd 0 e ,`� New Service Amps Volts Overhead 0 Undgrd 0 o� r Number of Feeders and Ampacity < o� Location and Nature of Proposed Electrical Work: Wire new furnace O Completion of the.161lowing table ma iv s ctor of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of _/ tal Transformers J�/` A No.of Luminaire Outlets No.of Hot Tubs Generators 3 A 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 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers 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 Sins 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 4•••••-• 4.. _____ .az....I.N Commenuesaide 01 rfiamachusetb Permit No. !.T4 laiWii Zepti,b4B rit al 5ire Scri,iGe.1 t---'1' Occupancy and Foe Chocked ".••'',;-. BOARD OF FRE PREVENTION REGULATIONS , -"t t••••,..b'ink) . APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A!.,(•rk to bc po.,:,e.tned,:11,:,, '• ''' ..- ' . • ::1-1.Li .•52SCIfkR 12.,;() (PLEASE PRIV T I.\'INK OR TYPE ALL I.\POR.11'ITO.V, Date: , -- ----:-:--7--- City or Town of: _ To toe I?spec-tor of If ire's: By this application th)undersigred gi es•otice I.his 6-her'i=toil....,...orforrt '-o:'lei:treat ourk descriMi bdoss.Location(Street&NtAter..) , Owner or Tenant____.Vk. Telephone No. Owner's Address Address_ . 4/A—(___ 7/ Is this permit in conjunction with a building permit? Yes ni No D (Check Appropriate Box) Purpose of Building Utility Authorization No. -- Existing Set,ice Amps Volts Overhead 7 I ndgril El No.of Meters r--. Ness Sersice Amps ; Volts Overhead El I ndgrd Li No.of Meters Number of Feeders and Ampaeity Location and Nature of Proposed Electrical\Nod:: uti6re C I — No.of —Ttitil •No,of Recessed Luminaires No.of Ceil.-Susp.(Paddle)I 'Transformers KVA-- KA.% No.of Luminaire Outlets No.of Hot Tubs iGenerators ____... Above r— In- r--- INo.of ErnergalTT.Wfig No.of Luminaires Swimming Pool grnd. ,--- grnd. '----L atters Units No.of Receptacle Cutlets No.of Oil Burners •FIRE:XLARXIS iNo.of Zones ---- \6:7-it DT•tection and No.of Switches No.of Gas Burners initic ting Des ices _ -----rItal No.of Ranges No.of Air Cond. T No.of Alerting Devices .....__ Heai-Pump Number 11 on, IKN's - N'O.of Sell-Cuntained No.of Waste Disposers 'Totals:I i. DetectiorfAlerting DO ices I oval IT:CfEmiciP0 1-7 Other No.of Dishwashers iSpace•Area Heating KW • —Connection 1--, ,, I Heating Appliances KVS• Seru7liTss stems:" 1.:().of s,ryers No.of Des ices or Equivalent No.of Water — No of KV% - • No. if [Data wiri :ng i Heaters Signs Ballasts I No.of Devices sir Equis oleos I Ti il-Ti----,mrriunications W iring: I No.H)dromassage Bathtubs No.of Motors Total HP I ; o.of Devices or Loh alerB__—, IOTHER: 1 Eslimated Value off_fctriat V,,jo-k: (When requiE.od b...municipa;Pale:. •work te star:: Inspootio:-.,:o be requested in ae,..07•!a:tee with I‘li.C.Rule II..ae.ad upon outrpetion. INSURANCE COVERAGE: Lilies,war cc by the ow no-.cc permit for 1...,:pc:1-tHn,lcc of;1cc:'ical e.ark m....issue JnIcss the licensee pro:ides proof of harility ' :min,,:including-completed operatico-co•.et-qt:or it,substomia:Nut,alert:. Th.: under.ig,:ed cortiries tha:such eo,erage is in torce.on,.I hi,evribitod r roof of soolo to the per,tit i,,,t;ng ofti:i , CI ILCK tiNL: INSL:e.ANC.r."X....,_BOND n OTHER D (Speeily: (..40,/k)laS0541,te iicif,i s,,)• --- I certif5.,under the pains and penalties of pethoy,that the infrrmation on this application is true and complete'. A.C. FIRM NANIE: C '` ' -. _ --- LIC.NO.:_faL5 A--- __ . _ . _ Licensee: er-/c__ iz Signature -.e----- --- NLIC. ez- ------ •, Bus.Tel. Address: 1,12, 4,_ i " ' All.Te. .Pci.M.G.I.,c 147.s.57-61.security work re.uitres De itruni..t of Pul;T:.Safety------ Jcense, Lie.Na OWNER'S INSERA NCE WAIVER: I am tlitre that the Licensee dui,got hare the:iabiltiv IlliUralICC co,er:-Oge normall% required ha as. By to signature below.I hei-eba war.e this Ft:quit-env:tit. I am the(check one....Q.=111;!. 2...2 'ner i 0 1`, Owner/Agent Signature _Telephone No._, .R.111T FEE:S