Blde-19-006409 Commonwealth of Official Use Only
of Permit No. BLDE-19-006409
Massachusetts
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/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:5/13/2019
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) 182 OLD TOWNHOUSE RD N (O k-Atil 4 (
Owner or Tenant ANDERSON KENNETH A Telephone No.
Owner's Address C/O JOHN MCMULLEN, 186 SHEEP POND CIR, BREWSTER, MA 02631
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: Upgrade lighting. (UNIT B)
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
Imtiatine 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 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 Siens 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: Paul M Morris
Licensee: Paul M Morris Signature LIC.NO.: 17520
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: PO BOX 213,1 COUNTRY WAY,SAGAMORE MA 025610213 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: $80.00
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"' Cotnmonweat k of 7fiassacluedatts Utticlal Use Only
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' , '� cc77� Permit No_
6 ;fit 2epartment o/...fire Services
1'�. �' Occupancy and Fee Checked
'':r,`�/,° BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION FOR PE 7'MfT TO PERFORM ELEC`r DGAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: j r ' /67
City or Town of: A-tl/l.�u� . To the Inspector df WI es:
By this application the undersigned 'ves notice of his or her intention to perform the elec cal work descrihedibelowil
Location(Street&Nmber) I 1 7, o ' I p-•�i �, {\., i --
Owner or Tenant 1 l 1D k Pr I..4 AkQ dk 1r-F7 i--- Telephone No. D 3 i- 8'
Owner's Address 5 " ' I 1 (o
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd D No.of Meters
,New Service Amps / Volts Overhead❑ Undgrd
b ❑ No.of Meters
Number of Feeders and Ampacity _
Location and Naturej (�of Proposed Electr' Work: I Q--( ' '`
tw,
' 3) Completion ofthe.followingtable 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 Ag i owe ❑ In- ❑ No.of Emergency Lighting
mod• grnd. Bad 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. TonsTol 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 HeatingKW Municipal
P Local❑ Connection 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Data Wiring:
Ballasts
Signs Ballasts of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring
No.of Devices or Equivalent
OTHER:
' Attach additional.detail([desired,or as required by the Inspector of Wires
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: � inspections t'tequested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVTRAGE: 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 ❑ (Specify:) •
I certify,under e pains and penalties ofperjwy,that the information on this application is true and complete.
FIRM NAME:
'{�1 In �-�P Chin' L (JZN L _ LIC.NO.:
Licensee: ( l p2e.aS l Signature/ jl.," LIC.NO.: I'i6ZJ/�'
(!f'applica t err 'exempt"in the l' ense number line,) Bus.TeL No.:�aD? --/1 b `1 L4 y
Address: 0 laa' -. 1012 S-t ill° p A- Q,L G 6 1 Alt Tel.No.:,TD 1, ' DI) 01,39
*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 onel❑owner ❑owner's agent.
Owner/Agent �y
Signature . Telephone No. E IT FEE: b ,
t p. � k
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