Blde-21-001780 r Commonwealth of Official Use Only
tintstMassachusetts Permit No. BLDE-21-001780
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:10/6/2020
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 describe low. �� )) ^ _w 1
Location(Street&Number) 29 KERRY CT k ,��t� 4A
s_ 4-1
Owner or Tenant B Telephone No.
Owner's Address 29 KERRY CT,WEST YARMOUTH, MA 02673 /_
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriat ) 1,
Purpose of Building Utility Authorization No. �✓��J ��/
Existing Service Amps Volts Overhead 0 Undgrd 0 •ter Oei
New Service Amps Volts Overhead ❑ Undgrd ❑ 44,
4.
Number of Feeders and Ampacity O
Location and Nature of Proposed Electrical Work: Receptacle for gas fireplace. 0
O 4,4
Completion of the following table may be waived by I s,.s,..._ o fires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ' 'a.
Transformers
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 1 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatine 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 ❑ 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 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: ARTHUR P DOHERTY
Licensee: Arthur P Doherty Signature LIC.NO.: 17197
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:372 YARMOUTH RD, HYANNIS MA 026012043 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
N1k4l-0(
1 /� /ems' ( ` Official Use Only
l-OJMMfO►tWtRL[A O j�Ud,6RFILId4ttEd
3' ' ir1 Permit No.
V (1 €
I * Occupancy and Fee Checked
;' �, BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
`i, All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 CMR 12.00
% (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I DJ�-J. (91-0
City or Town of: To the Inspector of Wires:
iBy this application the undersignyglititp(0)
gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) p29 KcrrtiC,f' We S-I- y rtu f-A
Owner or Tenant Krj -I(,t,e- c((a„hk,f1 Telephone No.508-em-o100P
£ Owner's Address 019 Xerr y Cy- Wr'st- V11MAD4411 .A 74 002-&73
Is this permit in conjunction with a building permit? Yes 0 No C (Check Appropriate Box)
i Purpose of Building �Qtstde G(,( Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
tv New Service Amps / Volts Overhead 0 Undgrd El No.of Meters
' Number of Feeders and Ampacity.
Location and Nature of Proposed Electrical Work: Wi eiiil Q r 9Q s ci epLLL c
Completion of the followingtable may be waived by the InsTector of Wires.
.(Paddle)Fans Transformers KVVAA
: No.of Recessed Luminaires No.of Ceil-Susp. Tr. f Total
1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
(Z.
No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting
grad. grad. 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
Total
No.of Ranges No.of Air Cond. Tons 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 Heating KW Local❑ Municipal ❑ °ther
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: 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 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 X BOND ❑ OTHER 0 (Specify:) JDWhin a'Neil
I certify,under the pains and penalties of perjury,that the information on this application(is true and complete.
FIRM NAME:
, l'yySIde 1FJecf✓iC�c1 Cv/gAG,�• IC.NO.: 4-17jg7
Licensee: /TYlILY P, Ao►iPr Jr- Sig,iff 4 _. .." . , L IC.NO.:
(If applicable,enter"exempt"in the license n_u ber line. r� / :us.Tel.No.: 5 - -Tt -7O
Address: 51 /l(td TeCk )✓ WP.S}line.
cYi A44 027 Alt.Tel.No.:
'Per M.G.L.c. 147,s. 57-61,security work requir s 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 one)[]owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 6—D. DO