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Home My WebLink AboutBLDE-22-006113 0,, Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-006113 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:4/25/2022 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) 15 HORSE POND RD Owner or Tenant Jacob Bell Telephone No. Owner's Address 15 HORSE POND RD,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Boat Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. Completion of the following table mar 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. grad. 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. 1 Tot No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons ION 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 Siens 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 ❑ 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: $50.00 ^1, ar.N G[[[ � Commonwealth O/ii/aimeXttSeW ^ f) ---_._ a ,� rycy,� c��7 nn ificial Csz Only • a' R 2epartnwrtl o`,}ire Jerriaea I Permit No. i L t If BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked �[Rew -C�i] ('ea,e blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK :\i.c.or:e;o be performed in accordance kith the Massachueans Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A L I1 F :Lf.9 TIO.V) Date: City or Town of: oBy this application the undersigne ises notice of his or c mention• eTo to the eespec ea!work dires: escribed below. Location(Street&Number) D. Owner or Tenant_ Owner's Address_ �k Telephone No. V t�-V Is this permit in conjunction with a building permit? Yes — Purpose of Building ❑ NO ❑ (Check Appropriate Box) Utility Authorization`:o.__`_ Existing Service Amps / Volts Overhead ❑ Lndgrd❑ No.of Meters __ New Service Amps I Volts Overhead Number of Feeders and Ampacitc Li Undgrd El No.of Meters Location and Nature of Proposed Electrical Work: V it (Q rj �-ec(go[p �7 � __ Completion,t the following table mar to wited/n the Lis tec for of li 7res. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)IIhhh1 ° ° Total ransformers K\'A No.of Luminaire Outlets No.of Hot Tubs enerators K\'A No.of Luminaires Swimming Pool Above Co.o mergencr Lighting grnd. attery L nitsNo.of Receptacle outlets No.of Oil BurnersIRE ALARMS , o.of Zones No.of Switches No.of Gas Burners o.o erection andInitiating Devices No.of Ranges No.of Air Cond. T —To.of Alerting Devices No.of N'aste Dis osers Rat Pump Number Tunp Totals: o.o e -.ontaine etection/Alertin DevicesNo.of Dishswashers Space'Area Heating KNcal unicipa❑Connection ❑OtherNo.of Drees Heating Appliances cu h'Systems:* No.of WaterKW o of NoNo.of Devices or Equivalent Heaters nta Wiring:Signs Ball ,No.of Devices or Eul%alentNo.Hdromassage Bathtubs No.of Motors Totalecomrnunications\\firing: No.of Devices or Equivalent OTHER: Attach additional detail it desired.or as required by the Inspector of Ii ire,. Estimated Value of Electrical Work: (When required by municipal policy's Work to Start: Inspections to be requested in accordance with MEC Rule IC.and upon completion. INSURANCE COVERAGE: Unless wai\cc 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 offic•. CHECK ONE: INSLRANCE�,BOND 0 OTHER 0 (Specify:) 144/u)l6t�sC6ivte 1/y 1 'a- 1 certify,under the pains and penalties of perjury,that the information an this application is true and complete. FIRM NAME: C lA L-t) Licensee: _ ,eCt.) _ LIC.NO.: 1 If�>/� /If applicable.enter"earn t.j the lieense number Inlet Signature — LIC.NO.:,�7a.3�L Address: � Bus.Tel.No.: 7 _S 07d-3"Per M.G.L.c.147•s.57 61,security work reawres De artmw.t of Public Safety"S''License: Alt LTel.c.No..: p$737 c(4A y OWNER'S INSURANCE WAIVER: lam aware that the Licensee does not hare the liability insurance coverage normally Owner/Agent byg law.aw, By myn signature below,l hereby waive this requirement. I am the(check one []owner owner's a�� wnrd Signature Telephone No._----_ PERMT FEE:S