E-20-646 ti9\1 Commonwealth of Official Use Only
E. t. • Massachusetts Permit No. BLDE-20-000646
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:8/5/2019
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) 32 GORDON LN
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 0 No ❑ (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: Bonding&wiring of pool.
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 0 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 ❑ 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: BRIAN A SMITH
Licensee: Brian A Smith Signature LIC.NO.: 24307
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:20 GELDING CIR, BARNSTABLE MA 026301503 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:$135.00
r /�
_ - Commonwealth of///assaeffs Offs ' Use Only
':Si', - 1J oarfinr ol.yin Serviced .'.. '` ..'i
Permit No. 01+ -�- 1 �J
BOARD OF FIRE PREVENTION REGULATIONS e . uo ] and Fee Checked
fRv 1/07 (leave blank)
r- --Z APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00
�F, I w
Lj PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date:
—'I r_ I a City or Town of: YARMOUTH To the Inspector of Wires:
l w y this application the tndersigned gives notice of his or her intention to perform the electrical work described below.
LU ,� a cation (Street&Number) , ( eI1O c/ z•
V � a Z Jp/�/
,o ner or Tenant (c� 5j/) /� Telephone No.
i
U i - J wner's Address 3Mjp/f
: rem
s this permit in conjunction with a building permit? Yes Er No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service ,j'l) Amps /do /..7yo Volts Overhead Le Undgrd❑ No.of Meters f
New Service Amps / Volts Overhead Und rd
e) ❑ l; ❑ No,of Meters
p Number of Feeders and Ampacity
c.
Location and Nature of Proposed Electrical Work: / Jy4/,f4 zi is tJ/ / ( may}_. /
' Completion of the following table may be waived by the Inspector of Woes.
44.
No.of Recessed Luminaires No.of CeiL-Snsp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs G nerators KVA
- No.of Luminaires Swimming Pool Above ❑ In- LrJ .of Emergency Lighting
sand. Qrnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1N• o.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatins;Devices
No.of Ranges No.of Air Cond. Ton No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number l Tons I KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Loth❑ Municipal
Connection ❑ Othr
No.of Dryers Heating Appliances , Security Systems:*
No.of Water No.of No.of Devices or Equivalent
\D Heaters ' No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No.H dromassa a Bathtubs Wiring:
y g No.of Motors Total HP Tel No.of Devices orEquivalent
OTHER: _
Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work (When required
In quired by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
t 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 p ns and pena�s of perjury,,that the information on th' pplic • is true and complete.
oi FIRM NAME: 0,e 9A/ ✓47/77/
LIC.NO.:
‘' Licensee: .�, pize Signature
(If applicable,enter/ empt"in the license numbe line.)/ C.NO.:
Address: �Q �FL,4JN C/ A e T IC Bus.Tel.No.:SDSi 9 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 n— o —
S required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner
Owner/Agent ❑owner's a enL
Signature
Telephone No. PERMIT FEE: $ f'js-�