Blde-22-003333 or Commonwealth of Official Use Only
f� Massachusetts Permit No. BLDE-22-003333
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:12/13/2021
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) 46 MINNETUXET WAY
Owner or Tenant BASLER BRIAN D Telephone No.
Owner's Address P 0 BOX 119,YARMOUTH PORT, MA 02675-0119
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: Install generator
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 1 KVA 1191
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
Initiati.ne Devices
No.of Ranges No.of Air Cond. Ton l No.of Alerting Devices
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 ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Eauivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Siens No.of Devices or Eauivalent
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 W SPRINGER
Licensee: David W Springer Signature LIC.NO.: 21170
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:70 Bishops Ter, Hyannis MA 026012106 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 my
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
A it Coi utr t--1i3 (24. Lei
��.� oZ /2/2.7
RECEIVED (,uif( COt-e-e
c SIG I-1
I-. DEC 10 2021
_. :DING I N G D E PA RT M nwsa o fsaaac�uaa(fa Official Use Only
-3333
.4 ; cc�� n Permit No. �iZ
f1 ,li.� r. I spartmsn,o`. iro Serviced
�' LI Occupancy and Fee Checked
,J ` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07j (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WO
RK
'J All work to be performed in accordance with the Massachusetts Electrical Code(MEC),W CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: t --ti IL J�.i
City or Town of: YARMOUTH To the Inspector ojrWires:
(Ni By this application the undersigned gives notice of his or her intentionti to perform the electrical work described below.
Location(Street&Number) I, jA('1 (le_ J k2\ LiLk j WIC r
NOwner or Tenant �;• ,4A -e,\ Telephone No.
Owner's Address
V_1 Is this permit in conjunction with a building permit? Yes ❑ No' (Check Appropriate Box)
NI of Building `'�Z" j,,, ,, Utility Authorization No.
C Existing Service Amps Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
^� Number of Feeders and Ampadty
`�► 1 Location and Nature of Proposed Electrical Work: j Li W 1�n•u, (-
kri
eo Completion of the following,table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-Sos No.of Total
,,,/ p.(Paddle)Fans Transformers KVA
'Z No.of Luminaire Outlets No.of Hot Tubs Generators KVA
A No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. and. 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
r No.of Ranges No.of Air Cond. Total
Tons No,of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.oTSelf-Contained
Totals:I "I_ Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local Municipal
❑ Connection ❑ fie'
No.of Dryers Heating Appliances KW Security Systems:*
No.of No.of Water KW No.of No.of Data Wirinevices or Equivalent
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 lectrical Work: 7(Q1, - (When required by municipal policy.)
Work to Start: U1% 13 2l Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVE GE: 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 cove a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: S 't\c t ..0 eJ'(i LIC.NO.:Z\1'10 ��
Licensee: 4, y c,,/1 -ex Signature \_ LIC.NO.: -5_, ('
(If applicable,enter"exem t iin the ense number line) ;'1
Address: '1 D b IS k.'0 S k-1' ViriAA ) Bus.Tel.No.: tit,` �k'� G)
*Per M.G.L.c. 147,s.57-61,seburity work requires Department of Public Safety"S"License: Alt.LiTc.e.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 one)❑owner 0 owner's agent.
Owner/AgentI
Signature Telephone No. I PERMIT FEE:$ -2-
-' )
2.",
ks
Slue/ -'a' oN 1 '%�f1'mv' 104-4-uci.xy y(0 $flt/1 V,W 9ncam4
-2igJvf-f/cf xrv....41W--e-d1 r`'/ r" +JS `7r-"(f.ct.cly J/4C-414fty