Blde-20-001972 Commonwealth of Official Use Only
Permit No. BLDE-20-001972
E Massachusetts
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
- jRev.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:10/9/2019
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perto he electrical work cribed below.
Location(Street&Number) 42 PEBBLE BEACH WAY 1'b -h VII.& ,
Owner or Tenant Telephone No.
Owner's Address 42 PEBBLE BEACH WAY, SOUTH YARMOUTH, MA 02664
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: Check wiring for finished basement that was done without permits or
inspections.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 2 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 7 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 1 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: WILLIAM M MASSEY
Licensee: William M Massey Signature LIC.NO.: 28400
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:26 DWIGHT ST,WORCESTER MA 016032385 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:$75.00
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BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IA 80
Occupancy
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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: — 9
City or Town of: YARMOUTH To the Inspector of Wires_
By this application the pndersigned gives n ' o her intention .
. Location(Street&Number) _ e electrical work described below.
Owner or Tenant 0>4v! !v,91 //1
t. Owner's Address Telephone No. 06P//
Is this permit in conjunction with bolding permit? Yes
� � Purpose of Building � � �g N° ❑ (Check Appropriate Box)
`eQ..S`6 l ,,,S>D Utility Authorization No.
Existing Service/0 0 Amps ` l 'OVolts Overhead Und /
�❑ No.of Meters
o New Service Amps / Volts Overhead
lI Number of Feeders and Ampacity El Undgrd ❑ No.of Meters
•
-'
Location d Nature of Pro s Electrical Work
fe7-ip,
Completion of the following table may be waived by the Inspector of Wirer.
No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of Total
No.of Lam;aa:r,. Transformers KVA
Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Abodve. d. �❑ In- 'No.of lirmergency Lighting
gra . B Units
No.of Receptacle Outlets 2 No.of On Burners
/ FIRE ALARMS No.of Zones
No.of Switches / No.of Gas Burners • • No.of Detection and
No.of Ranges Na of Air Cond. Iuihatmg Devices
o No.of Alerting Devices
Tons
No.of Waste Disposers eat Pump umber Tons o.o elf ontai
Totals: Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Loc unicipai
No.of Dryers HeatingA ❑Connection ❑ Other
Appliances Kw
Security Systems:*
o,of ester No.of Devices or E ' alent
Heaters KW °'° o.of Data Wiring:
J Si s Ballasts
No.of Dvices or E uivalent
No.Hydromassage Bathtubs No.of Motors Telecommunications Wiring:
Total HP No.of Devices or trivalent
Ili
OTHER
�+ Estimated Value of Electrical Work (� Attach additional detail if desired or as required by the Inspector of Wires.
Work to Start: (When required by municipal policy.)
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 ma ism
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalenty The
unless
NIA undersigned certifies that such cove a is in force,and has exhibited proof of same to the permit issuing office. Th
4 CHECK ONE: INSURANCE [�BOND 0 OTHER 0 (Specify:)
!certify, under the and
FIRM NAME: penalties ofpolury,thatthe information on this application is true and complete.
LIC.NO. { _- Licensee:k Signatur
i (If app 'cabl ter'ex t"in the li e ) (% i LIC.NO.:
' Address:/ bar!' e
Bus.Tel.No.• `p?
J `Per M.G.L. c. 4 ,s.57 security work requires Department of Pub c SafetyAlt.Tel.No.: �/ v
�z
OWNER'S INSURANCE WAIVER: I am aware that Licensee does not have the liabilityLin.No.
• required by law. By my signature below,I hereby requirement insurance coverage normally
waive this I am the(check one ❑owner El owner's a`ems;
1 Signature