E-18-6946 a
Commonwealth of Official Use Only
E•.7�� Massachusetts Permit No. BLDE-18-006946
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.l/07j
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (IvtEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIOIJ) Date:6/6/2018
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. Lpp r� 9
Location(Street&Number) 32 GORDON LN JU D^ I 7687
Owner or Tenant MELO CASSIO R Telephone No.
Owner's Address 32 GORDON LN,YARMOUTH PORT,MA 02675
Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No. j
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: Remodel basement
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 14 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- o No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones 1
No.of Switches 8 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 0 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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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
signature below,I hereby waive this requirement.I am the(check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$75.00
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eeJ (T/2 f 11/c > ivir) 4/ri4e et.-
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✓ .� Commonwealth of ya
esachuteife ` l Use Only_ Permit No. OOQ=_iiwi �eparimenf clam Stwice!
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-'=� Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS ev. 1/07] (leave blank)
APPLICATION FOR,PERMIT TO PERFORM ELECTRICAL WORK
/ All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
N'O
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: YARMOUTH To the Inspector of Wires: .
By this application the undersigned gives notice of his or her intention to perforz,the electrical work described below.
7 . . Location(Street&Number) 3.2 6,,, d,,„1 /At — yA2ucom Voj{ 16 1 02.6 7 j
OwnerbrTenant t^s155to 19/c) Telephone N(5*)3(�_
Ownbr's Address 6t-A-Q
01-If the s permit in conjunction with a building permit? Yes cgiNo
ao 0 (Check Appropriate Box)
se of Building LNm9/04. j.tSP,etpivT UtilityAuthorization No.
'y `co Iii ng Service /G1 Amps / Volts Overhead Undgrd❑ No.of Meters p/
co
( e O ew service Amps / Volts OverheadUndgrd 0 gr 0 Ne.of Meters
V = umber of Feeders and Ampacity
uJ —' Olt on and Nature of Proposed Electrical Work:
I
:J ,
m CD
1 Completion of the followinvable may be waived by the Inspector of Wires.
No.of Recessed Luminaires 4 �y No.of CeiL Snap.(Paddle)Fans No.of Total
�
Transformers KVA
No.of Luminaire Outlets 4ft,40 No.of Hot Tubs Generators KVA
• No.of Luminaires Swimming Pool Above 0 In- 0 No.orttery UnEmerg
itsency Lighting -
grnd. grid. Ba
No.of Receptacle Outlets No.of O0 Burners FIRE ALARMS INo.of Zones ,e
No.of Switches 6 —(1 No.of Gas Burners No.of Detection and
• • Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump 1 Number Tons KW No.of Self-Contained
Totals:1 I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW' L0oai Municipal
Connection 0 other
No.of Dryers Heating Appliances KUV Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of 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 ifdesired or as required by the Inspector of Wirer.
Estimated Value of Electrical Work: „,, p0
� (When required by municipal policy.)
Work to Start:Syu.' /5-1#2.•I 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 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:
LIC.NO.:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license nwnber line.)
Address. Bus.Tel.No.
J *Per M.G.L. c. 147,s.57-61,securitywork requiresAlt.Tel.No.:
Department of Public Safety"S"License: Lic.No.
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By m signature below,I hereby waive this requirement. I am the(check one) 'owner 0 owner's a eflt.
Owner/Agent
el
Signature Telephone No. SC$-.%o5dd11 PERMIT FEE: $ 1J' 1