Blde-20-001084 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-20-001084
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:8/27/2019
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) 16 GARDINER LN
Owner or Tenant MCDERMOTT ROBERT B SR TRS Telephone No.
Owner's Address MCDERMOTT MARGARET M TRS,46 VILLAGE RD, PAXTON, MA 01612
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&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
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 No.of Detection and
Initiatine 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/Alertinc 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 ,Sicns 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 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 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: DAVID W SILVA
Licensee: David W Silva Signature LIC.NO.: 20608
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 THISTLE DR,CENTERVILLE MA 026322036 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) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
aet 1(I (I
l.ommonweatth o`Masaaeliuseth Official Use Only ,
' Ail' '� • Apartment
cc77 Permit No. t S Lkt ail 1Jepartment o`Jirs�arvice.4
{ '' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
' � [Rev. 1/07] (leave blank)
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1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
V All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 2.00
" „(FLEA$E.F,RINTIN INK OR TYPE ALL IIVFOPMATIOIV) Date: 8� ' d�j9
€
r '- ,city or Town of: y ,/lip of•/9 To the Inspector of ires:
LL9 l Bthis! p_cation the undersiged gives notice of his or her intention to perform the electrical work described below.
��
P I1oaati4C( {treet&Number)�/j �Bf �jr f Z� Se' �/'A//M�gig
' p /� �C/ c� ff Telephone No. / 904/$
9 F i enant /7O16i'i/f /E e
0 Omaert'iOdress ,52,2 fib
! Lu s Is is p ri4it in conjunction with a building permit? Yes ❑ No 14, (Check Appropriate Box)
1 --- urrpesiamof Building Utility Authorization No.
`' ----Ezlct1ng'S'rvice Amps / Volts Overhead❑ Undgrd
gr ❑ No.of Meters
New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
Number of Feeders and Ampacity -
Location and Nature of Proposed Electrical Work: /;,/f�. s v 6 .�te.14/4r,t1 ,7 f s.74"j,
Z
Completion of the following table may be waived by the Inspector of Wires. j
NroNo.of Recessed Luminaires No.of.CeiL�nsp.(Paddle)Fans of Total
Transformers KVA
Ili ,
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
VA
Above In- No.of Emergency Lighting j!
No.of Luminaires Swimming Pool grnd. ❑ grnd. 0 Battery Units _
,� No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
V
No.of Detection and r No.of Switches No.of Gas Burners Initiating Devices
No.of Ranges No.of Air Cond. Toil No.of Alerting Tons Devices f
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 Municipectional 0 Other
Conn
HeatingAppliances Security ytems:*
1 No.of Dryers pp ICGV No.of Devices or Equivalent
No.of Water KW No.of No.of -Data Wiring:
N.
Heaters Signs Ballasts No.of Devices or Equivalent
Vr) No.Hydromassage Bathtabs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
\�) OTHER: •
• Attach additional detail if desire4 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 permit issuing office. ,
CHECK ONE: INSURANCE ❑ BOND 0 OTHER 0 (Specify:) •
I certify,under the sins and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME:"e e' '/e"..�, c/1 CA/p.P/ J2 ' LIC.NO. Of USA .
• Licensee:62y�,'V,i7 C/�,/ Signatuf y,1 4,4, LIC.NO.y9n p
(If applicable,enter "exempt"in the license number Bus.Tel.L No.
Address: t- `'K d`.C.4974 /.+1Sfil'fr iefe/i/i2!''A C//js�A, • Alt TeL No.:5OF.7.r eV/6 .
*Per M.G.L.c. 147,s.57-61,security work requires 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 my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent.
Owner/Agent Signature Telephone No. I PERMIT FEE: $ 6-0—