Blde-18-006851 �' Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-18-006$57
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
IRev.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:6/4/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. e
Location(Street&Number) 46 CAMP ST Fb9',-f/` -r3 .
Owner or Tenant DOUGLASS KATHERINE D Telephone No.
Owner's Address 46 CAMP ST,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 0 Undgrd 0 19. i f Meters
New Service Amps Volts Overhead 0 Undgrd 0 ..4(t4, ers
Number of Feeders and Ampacity4dtt4i,"1/
Location and Nature of Proposed Electrical Work: Replace devices and install arc fault C/B. ?0
Completion of the following tos • • t• .t' tor of Wires.
_
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Q
Transformers A _
No.of Luminaire Outlets No.of Hot Tubs Generators 40' VA
No.of Luminaires Swimming Pool Above ❑ In- I: No.of Emergency Lighting O
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: Rich M Melvin
Licensee: Rich M Melvin Signature LIC.NO.: 11476
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:8 REARDON CIR,S YARMOUTH MA 026641207 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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Commonwealth of/r/addachudrftis Official Use ly
'' e e g5 Z'' c� /7 Permit No. /
_ __rn�=-' Apartment o �Serviced
' Occupancy and Fee Checked
\ f BOARD OF FIRE PREVENTION REGULATIONS {Rev. 1/07] (leave bl
d'4 . . -
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: l! /1 //g
City or Town of: YARMOUTH To the inspector of Wires:
By this application the Endersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number) t (P 6/IL/viol S e-f- `U 'A A✓A j c, 6,7 3
Owner'or Tenant JL -I-h crx..4or L/D U I ek-C_ Telephone No. sae 2qo) y
Owner's Address '
mtr A 49 Aa:,C
Is this permit in conjunction with a building permit? Yes ❑ No
(Check Appropriate Box)
..a, purpose of Building )0o ce /,l L; Utility Authorization No.
`r"r-;-- •Exi5tiQg Service Amps / Volts Overhead ❑ Undgrd
_1 ❑ No.of Meters
`� New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
��( ` o .vJ Nit nb r of Feeders and Ampacity
^ � ' 1 Location and Nature of Proposed Electrical Work:-7�_ t
'� fi ctJrGC' �lB["GCY1�-v� 1/! �at�'2"i+'ik�Llf /�}�/.
Z. Li; * '; /4c-FR lle,6Cn OF tC vit % etc
A- I( Completion of the following table may be waived by the Inspector of Wires.
k No.of Recessed Luminaires No.of Cell.-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 No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners • No.of Detection and
• Initiating Devices -
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
•
No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKWunicipal
Low Ti❑Connection ❑ Other
No.of Dryers Heating Appliances , Security Systems:*
No.of Water q
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:
1 Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: `'
(When required by municipal policy.)
6 Work to Start: a
1 i ctions to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE O ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
NI 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:)/lig ee/c /2
I certtfy, under the ins and penalties of perjury,that the information on this application is true and complete.
FIRM NAME• ,�y�
11
/C/�/'ccrt�r�./, L6-G /Ci,i n /� LIC.NO.:
Licensee: j4 �vLL�i.N Signature LIC.NO.: y
(If applicab e,enter"exempt"in the license number line.) — _/ —
Address: / Bus.Tel.No.: s'aP ✓irr,Cri
j *Per M.G.L. c. 147,s.57-61,security work requires Department of Public SafetyAlt Tel.No.: 7 7 y` Od'Lls9 S
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
S required bylaw. Bysignaturehereby
qm m y below,I waive this requirement. I am the(check one)0 owner El owner's agent
7 Owner/Agent
Signature Telephone No. I PERMIT FEE: $ -�' 't)