BLDE-19-001756 ✓ Commonwealth of OfFcialUse Only
kfE•.R(►� Massachusetts Permit No. BLDE-19-001756 '
�7 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 ININK OR TYPE ALL INFORMATION) Date:9/24/2018
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 electrical work described below.
Location(Street&Number) 8 CAPT DORE RD
Owner or Tenant RUSS CHESTER H JR Telephone No.
Owner's Address RUSS DIANE E,8 CAPT DORE 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: Septic pump 8 alarm.
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 l
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- 1:1No.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
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 1
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 Data Wiring:
Beaters Siens Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail U-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: BRIAN A SMITH
Licensee: Brian A Smith Signature LIC.NO.: 24307
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:20 GELDING CIR,BARNSTABLE MA 026301503 Alt.TeL No.:
*Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"5"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
Signature Telephone No. PERMIT FEE:$50.00
L- 9/ 48(
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Comeronf"eaS vi Masse al Use
= c77� c'/ �i Permit No. CI.'" � j
iiii .11 TO! `.:.Jcpa^4rsnt o{.J`ix Serviced
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BOARD OF ERE PREVENTION REGULATIONS Occ¢pancyand FCC Checked
"0°' I/073 brave bleat)
APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance wit the Massachusetts Electrical Code I C),517 CMR l2.W
(PLEASE PRINT Di INK OR TTPE ALL INFORM47701V D ate:
City or Town of: YA_RMOUTH
To the l •eeto of Wires:
. By this application the wudersigled gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number) ♦ Li ui a a 14. . _ 00..i
Owner'or Tenant .d//--,v.�= /
-1?) — 7 Telephone No.
Owner's Address Li/Mb"
IsIs this permit in conjunction w a building permit? yes ❑ No ❑✓ (Check A ro Box)
Purpg PP Pr s�
1:143
m '� I �/� Utility Authorization Na,
ii civ �� E±Ingtifocs)1181113:12Nece:::L. /� 9 mPs /�cl l, lyf Vot s Overt ad IIndgrd
❑ No.of Meters
CNI �y New _ 4mps / Vohs Overhead❑ IIndgrd❑ tto.of Meters _
it' (m Numees and Ampacity
v c to LocareofProposedElectricalWork:wi ' _�i Ce
w m Completion ofthefolla"dnz table may be waived by tie Inspector of Dr"trar,No. ¢minaseso.of Total
Na.Noof Cetl�Snsp_(Paddle)Fans Transformers
No.of Luminaire RSA _
e Outlet Na,of Hot Tubs Generators • Ia'VA '
Na. of Luminaires Swimming Pool '1`bov` 0 in- IND.or&mergeaey Lin g
Brad. ernd. Eaffen Units
No. of Receptacle Outlet No.of Oil Burners
FIRE A.L-°RMS 'No.of Zones
No.of Switches No.of Gas Burners $No_of Detectiand
I4 Init at ng Devices
d.
No,of Ranges No.of Air Con
Tons No.ofAlerting Devices
No.of Waste Disposers Heat Pump I Number 'Tons I KW IND.of Self-Contained
Totals: De on/Alertin,Devices
V Na.of Dishwashers Space/Area Heating KW' Local Q Muaitdpal
Connee5on 0 Ctha
No.of Dryers Heating Appliances KW Security Syremc:•ces or E
No.of Water No.of Devi
No. of No.of q��ent
Heaters S.
KW Signs Ballast Data Wiring:
Na.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors / Total HP Telecommunications Wiring
OTHER /�
No.of Devices or Equivalent
1 -
•
/Mach additional derail ifdesired or as required the 1of
G Estimated Value of Electrical Work: 4 by Inspector Wires.
Work to Start (When required by municipal policy.)
Inspections to be requested in accordance with MEC Rule ID,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 it substantial equivalent The
Si
undersigned certifies that inch cov ge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCEIEr BOND 0 OTHER 0 (Specify:)
I certify,under the p.' and pe s of perjthat the information on this appgtasi n is true and caatpfete
FIRM NAME: 4i- G V //
Licensee _LW,:z2_:____ r— LIC.NO.:�
Signature LIG NO.: �,
Iv Of applicable.e, s� re .-.r"in the!' e b= r.
Address. . U I f i �/ L_ ` Sas.TeL No.
ay
Per M.G.L.c. 147,s.57-61,securitywork Alt TeL No.:_—
OWNER'S INSURAN requires Department of Public Safety"S"License: Lic.No.
ee bylaw. CE WAIVER I am aware that the Licensee does not have the liability insurance coverage nnooxma ly
requiredBy my signature below,I hereby waive this requirement I am the(check one)❑ owner 0 owner",a „„
t Owner/Agent �`
Signature /
1.11
Telephone No. I PERMIT FEE: $ Ll Li I