Blde-18-006208 i
• Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-18-006208
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:5/4/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform e e ctncat work described below.
Location(Street&Number) 39 MICHELLES PATH 1- ±Prt-1010
Owner or Tenant BARR DAVID R JR Telephone No.
Owner's Address BARR SHERRY L,39 MICHELLES PATH,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes ❑ 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: Remodel basement
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 6 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 6 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatintt 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/Alertine 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 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: Robert J Carlson
Licensee: Robert J Carlson Signature LIC.NO.: 16945
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:39 NAUSET RD,W YARMOUTH MA 026733752 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
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' Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 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
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:' J—/ - '
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her inten' n to prorm the electrical work described below.
Location(Street&Number) 39 Ityl i c.,hQ,[ �.s 'O f i
Owner or Tenant 0 n Telephone No bg—ZG'f y— d/p7
Owner's Address l �/y� j G�� PS
Is this permit in conjunction with a building permit? Yes Ei. No
•• ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service /QO Amps /24,ItY . Volts Overhead ❑ Undgrd❑ No.of Meters /
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 12CUZh. ( V\C(.it 10 -q'n I S k_
ev Se Y eivvi-.
Completion of the followinktable 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
grad. grad. Battery Units
No.of Receptacle Outlets ,4, No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas BurnersNi
of Detection and Initiating Devices
Total
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
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❑Co nicipal 1-1 Other Connection
No.of Dryers Heating Appliances KW '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 if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 60e2,U 0 (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 pains and enalties of perjury,that the information on this application is true and complete.
FIRM NAME: e� S�UICC2/* LIC.NO.:# /C �J't/s'
Licensee: .4a ' r:/T /� ���'
/l�w Signature��i.4.... 4, LIC.NO.:E 78.rC9
(If applicable, enter"exempt"in the license number ine.) Bus.Tel.No.:
Address: 2 9 H f09 S� ›.4",94/77.9 Alt.Tel.No.:
..j *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
S 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
I Signature Telephone No. l PERMIT FEE: $