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Home My WebLink AboutBLDE-23-002745 Commonwealth of Official Use Only f:oi► Massachusetts Permit No. BLDE-23-002745 �-' 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•11/17/2022 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) 11 HORSE WAY Owner or Tenant RODTS PETER B Telephone No. Owner's Address 11 HORSE WAY, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) /,✓ Purpose of Building Utility Authorization No. /`� Existing Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity ,,%r Location and Nature of Proposed Electrical Work: Replacement boiler. 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 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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 ❑ 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 ❑ 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 C.ommonseeaR 01 741.1.14chmidts Official Use Only,,/I� » ' ryy Permit No. Z3�Z7 T� ■ 2epartment o/5ira Services 1,1 !j V.,,, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked — [Rev.1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Ail murk to be performed in acccrdance with the Massachus,:us Electrical Cod (MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE A�LVFO rA4477O.N,) Date: I I—1/^ -)— City or Town of: Q f to To the Inspector of Wires: By this application the undersigns ice o'•e of s or her intention to pe,term the electrical work described b'low. Location(Street&)umber) t(� .✓ 11 iQ Owner or Tenant V � 3 't/ Telephone No./ 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: fni4tiC Pr Completion of the following table mar be waived hr the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans r. f Total T Tranosformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting grnd. grnd. ❑ Batten 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. Total No,a.AlertingDevices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal Connection ❑Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent Heaters KW Data Wiring: 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((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 force,and has exhibited proof of same to the perms ssuipp ffic}. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) �1[�/SG$vtp I6Oa e-(30-c; I certify,under the sins and p na es of er�ryry,"that the information on this application is rue and complete. FIRM NAME: 'W,(J -"vino 6.e.la-VC ,( �v LIC.NO.: �3��Fj/t Licensee: ' °y'1 L. . A R(,(� Signature a 1. III-applicable.ems('"�renr do�( ens n tber line./ LIC.l. NO.: �- Address: 9) 'II ll inrl (,�j Ilr LL r/ Bus.Tel.No.: *Per M.G.L.c.147,s.57-61,security work requires epartment of Public Safety"S"License: Alt.LiTd No.OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability required bylaw. Bym signature insurance0owner coveragew normally age 4 y below,I hereby waive this requirement. I am the(check ones❑ owner's agent. Owner/Agent Signature Telephone No. 1 PERVIT FEE:$