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Home My WebLink AboutBLDE-23-003513 Commonwealth of Official Use Only ffl ' Massachusetts Permit No. BLDE-23-003513 °ir-' 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:12/28/2022 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) 99 OLD MAIN ST Owner or Tenant GAGNON WILLIAM N Telephone No. Owner's Address GAGNON SHEILA A,76 CAPT CHASE RD, 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 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wire 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 F No.of Luminaire Outlets No.of Hot Tubs Generators 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 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. ,TI,°Onal No.of Alerting Devices 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 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 IIP 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: 12/19/2022 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 j Official Cse Only Commonwealth of Massachusetts I e Prmit No. CZ 3-331—/3 1 1 Department of Fire Services 1 Occupancy and Fee Checked 1. ( `1 (lease'olank) I i BOARD OF FIRE PREVENTION REGULATIONS Rey.9,0_ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ..\ll work to be performed in accordance with the Massachuseus Electrical Cede(ME-O.52'(-MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL l.VFOR. ATIO') Date: I l �` City or Town of: t etOin' (J To the Inspector of tfires: Bs this application the undersigned oji notice()fps or her intentionto perfomt �ec ncal work described below. Location(Street&Number) 19 �"D�'i`4_ t1 1� I M(V1 �� &�{S— Owner or Tenant AVI(,1IA LiV..N..+w(Lt. Telephone No. �' lb(o / Owner's Address is this permit in conjunction with a building permit? Yes ❑ No E (Check Appropriate Box) Purpose of Building Utility Authorization No._ Existing Service Amps Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacit Location and Nature of Proposed Electrical Work: („Aye (,,,O' lt/ Completion oldie following table roar be waived hr the In vector of'rims. No.of Total No.of Recessed Luminaires Na.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.01 Emergency Lighting No.of Luminaires Swimming Pool grad. C grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 1 No.of Switches No.of Gas Burners No.InitiatingiSeteon and di � Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Paste Disposers Heat Pump Number Tons KW No.of Self-Contained 1 P Totals: Detection'Alerting Devices i Mu No.of Dishwashers Space'A 0Corea Heating KW Local nnniciectiopaln 0 Other No.of Dryers ,Heating Appliances KWSecurity Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters _ Signs Ballasts No.of Devices or Equivalent No.Hytlromass ¢$athtubs No.of Motors Tatal HP Telecommunications ii iring: No.of Devices or Equivalent OTHER: .4:tacit additional detail if desired.or as required hi the Inspeetor of If'ire, Estimated Value of Electrical Work: (When required by municipal policy.I Work to Start: Inspections to be requested in accordance with MMEC 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 pros ides proof of liability insurance including"completed operation"cm erage or its substantial equivalent. The undersigned certifies that such coverage is in free,and has exhibited proof of sante to the unit issuing office. CHECK ONE: INSURANCE 0 BOND OTHER El (Specify) 1..(yi/ac'1r�( ndOV'er5Co""f g-?6 ?.3 I certify,under the pains and penalties ojperduty,that the information on this applicafli n is true and complete. FIRM NAME: /CO _ LIC.NO.: [3((�j Licensee: Signatur LIC.NO.: 37 (If applicable,!pier"sexenr t",,in a lit se t m iher line/)�� Bus.Tel.NO.• 7 Address: 1.1" ( �p(�I�(/ W f Alt.Tel.No.: 7 ` *Security System Contractor License required for this woFk: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, 1 am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ I