BLDE-18-006340 . 4(4'
;4 Commonwealth of Official Use Only
IAMassachusetts Permit No. BLDE-18-006340
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.//071
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:5/14/2018
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`ales al work described below.
Location(Street&Number) 8 CYGNET RD -C76 b PI I a Q L,td
Owner or Tenant BITETTI VITO L JR Telephone No.
Owner's Address 8 CYGNET RD,WEST YARMOUTH,MA 02673
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 0 No.of Meters
New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install range receptacle and add receptacles&lights to code.
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 ❑ - a No.of Emergency Lighting
grnd. Pim'. Battery Units
No.of Receptacle Outlets No.of OB 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.of Alerting Devices
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 ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW 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 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: JEFFREY T FOSS
Licensee: Jeffrey T Foss Signature LIC.NO.: 36938
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:33 SULLIVAN RD.W YARMOUTH MA 026733543 Mt.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
SignatureTelephone No. PERMIT FEE:$75.00
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BOARD OF FIRE PREVENTION REGULATIONS I Ooeapartcy and Fee Checked
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APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
.All wort to be pa formed in accordance wit The Massachusetts Electrical Electrical Code I %7 : I LOO
7 (PLEfiSEPRDJTINWKORTYPE ALL INFORMA770N) Date:
City or Town of: YARMOUTH
0 1.-
c..;,, By this application the em edTo the Inspector of"ices:
lmd . eves no:ce of his or het intention to perform th electical work described below.
W mrF Location (Street&Numb ) •
• G 4 no" ��
o 1
> �+� a •Owner or Tenant (i Telephone No Q _
W 1 a Owner's Address arlffi 11G 11l art O� �"Z
() i Is this permit in conjunction with a building
permit? Yes X No ❑ (Check Appropriztu Rot)
U.1 ° . Purpose of Building U Authorization No.
re = T
m io Existing Service AD Amps Pi/,2r0 Volts Overhead Undgrd❑ No.of Meters
New Service _ Amps / 7 Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
catch and Nature of Proposed Electrical Work. /gnr/1/�I»f/1�flP�' /ifira
ti 0
Completion of the followac;table may be waived by the Inspector ofrrrer.
No.of Recessed Ltimi e: of Cal.-Soso.Cal.-Soso.(Paddle)Farts • ITrans No.of Total
ormers KVA
No. of LuminireOutlet INo.vfHot Tabs IGeaerators KVA '
No.of Luminaires Y �` (.IJGt e ISwi,.,rrring Pool Above In- No.or amergeacy Ughtmg -
'rnd. 0 anti 0 IBat`ar9Units
No. of Receptacle OutteeSCalt No.of OE Fusers
FR2R.P3-4.c2M5 No.of Zones
Na.of Switches AA Cv AG INo.of Gas Burners No.of Detection and
' (�( Initiating Devices
No.of Ranges INo-of Air Cond. Total
Tots No.of Alerting Devices
No.of Waste Disposers (Heat Pump—Number Tons KW INo• of Setf-Contained
Totals: Detecuon/AlerldnaDavices
No.of D'ufiwashers 'Space/Area Heating KW' Loeai 0
l�itraidpal
Coanecdoa ?
No.of Dryers Heating Appliances KW .Security Systems:"
No.of
Q7 No.of WHeaters KW ater
No. of No.of Dzta WaVices or Egni4alent
`�sSins Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs INo. o{Motors Total Telecommunications Wiring,
v No.of Devices or Equivalent
i. OTHER f/r1Y/, rsv* -
Attach additional detail f derired or as required by the Inspector of Firer
Estimated Value o eccal Wort: ""------ (When regttired by municipal policy.)
-ii. Work to Start A /( Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C VE} GE: Unless waived by the owner,no permit for theerformance of electrical work
' i P may lent ess
the licensee provides proof of liabil• ity insurance including"completed operation"coverage or it substantial equivalent The
N. ) undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issnin office.
CHECK ONE: INSURANCE f4. BOND 0 OTHER 0 (Specify.) Cel ifeitelte le ///t"
I cart", ander the paint ant penal 7>4 of perf u-y that the information on this application is true and complete
FIRM NAME:
Licensee: ' •
TIC.NO.:
Licensee: ,Ana, Signature LIC.NO.: K
Address V /' f fA //,�Q'ffJlC tulTas. fj
J Per M-G.L. e. 1 7,s.57-61,seeunty work reyuna Department of Public S j'a'It TeL No.
ep Safety"S^Lic e: Lie.No. '
- am aware INSURANCE WAIVER: I aaware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner 0 owner's agent
Owner/Agent g
t Signature• Telephone No. . I PERMIT FEE:$ l