Blde-20-000455 or Commonwealth of Official Use Only
4\ Massachusetts Permit No. BLDE-20-000455
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:7/26/2019
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 12 YACHT AVE
Owner or Tenant SOARES DAVID(LIFE EST) Telephone No.
Owner's Address SOARES IRENE(LIFE EST), 12 YACHT AVE,WEST YARMOUTH, MA 02673
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 ❑ 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: Service repairs.
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
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 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:
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: David M Smith
Licensee: David M Smith Signature LIC.NO.: 31671
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:8 HOWARD RD, HARWICH MA 026453207 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
pantry nc-0 44 -
- = Commonwealth of///addac ffs Official Use Only
1 �_� _/ ep o{Jzrs Services
`� Permit No. �-0 gq�
BOARD OF FIRE PREVENTION REGULATIONS ev. 1/0/07] (l.Occupancy (l Fee Checked
v. eave blank)
isfl
14 APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code
(MEC),527 CMR 12.D0
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: „Tv 1-`1 a b , b j /
City or Town of: YARMOUTH To the Inspector of Wires: )-
By this application the pndersigned gives notice of his or her intention to perform the electrical work described below.
;,;e/) Location(Street&Number) 4 l Y 4 4 N 7-- i J t
Owner or Tenant 14- f 1 P` cJ Telephone No.� s' _ 1
_� Owner's Address --1 y
�. YA-c i-1 -r 4 v
Is this permit in conjunction with a building permit? Yes ❑ No
,� (Check Appropriate Box)
Y
Purpose of Building ' L i_ I A) 6- Utility Authorization No.
Existing Service 100 Amps ja0 / :ND Volts Overhead LJ Undgrd
❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd gr ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 0 N I_
Completion of the following table may be waived by the Inspector of Woes.
No.of Recessed Luminaires No.of Ce�1-Susp.(Paddle)Fans No.of Total
Transformers I{VA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires swimmin Pool Above In- No.of?Tr. Lighting _
g grad grad. � Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones -
No.of Detection and
No.of Switches No.of Gas Burners
Initiating Devices
No.of Ranges No.. of Air Cond. TOe No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Loral Q Municipal
Coection0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Ballasts -
Data Wiring
Signs 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 i Mm Y t 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 ❑ OTHER ❑ (Specify:)
I certify, ander the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
DrIV ( t� LIC.NO.:
Licensee: f i,, �M Ilk Signature 4414 ./
applicable, ' , LIC.NO.:
(Ij enter"exempt"in the license number line.)
Address: 6a G'c12. 1,, N S ►�/( �F (lac ,p Bus.TeL No.: -9'53
j Per M.G.L.c. 147,s.57-61,securitywork requires / Alt.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
S required by law y below,I hereby waive this requirement. I the(check one)El owner El owner's agent.
Owner/Agen am I Signature O Telephone No.5 r�Qg _d r-T [PERMIT FEE: $ hv----
00.2 y-