Blde-22-004120 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-004120
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:1/25/2022
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) 259 OLD TOWNHOUSE RD
Owner or Tenant Beth Henderson Telephone No.
Owner's Address 259 OLD TOWN HOUSE RD,WEST YARMOUTH, MA 02673
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 ❑ 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: Receptacle for fire place blower.
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 1 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
Ti
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerti l a 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 Eauivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Eauivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
_No.of Devices or Eauivalent
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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: KEVIN A CRONIN
Licensee: Kevin A Cronin Signature LIC.NO.: 11275
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:7 Liefs Lane, South Yarmouth MA 02664 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:$50.00
°�� 112 7
Commonwealth
`/ /�//� � Official Use Only
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l n~ BOARD OF FIRE PREVENTION REGULATIONS a�.110po 7]yaa cave lank)
[Rev.1/07] (leave blank)
1CI — !AF. PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
UJ>I An work to be perfexme l in atxorriance vittr the Ma,sachuseus Elea al Code/MEC),52 CMR 12.00
(I' ASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / c�y )'a--
P-12 hI CL4
W � City or Town of: Y ill _To the inspector of Wires:
0• ByTtiS application the undersigned gives notice of his or her intention to perform the electrical work described below.
W LO°atinn(Street&Number) c) S9 01-ID 7-tii.)/k1 J1--QI s el /2c,4
Ov/fc or Tenant B EThJ iit/•)o eil-S 0 e) Telephone No.7&-/ 7/0 (/3 G
Owner's Address c9S f 6 60 7z,co t) ikpte s c 2c , to,)94zovf-i,i/ mg-
Is this permit in conjunction withran a building permit? Yes 0 No (Check Appropriate Box)
CI l r se of Building U2 Si Utility Authorization No.
l W N is ng Service /ai Amps/ � / of Y6Volts Overhead Undgrd 0 No.of Meters /
kc-slV Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
W I � l�n of Feeders and Ampacity �//1
C") Q Lion and Nature of Proposed Electrical Work: -Mt AiU2 ELE�?ZI GAL , 0 iv G L 0 D u1Cied-
uj
mr
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 1
gNo.of Luminaire Outlets No.of Hot Tubs Generators KVA
U
No.of Luminaires Swimmin Pool Above in- No.of Emergency Lighting
0 gmod• LI z�rd Battery Units
OJ No.of Receptacle Outlets / No.of Oil Burners FIRE ALARMS (No.of Zones
8 I No.of Switches No.of Gas Burners 'No.of Detection and
Initiating Devices
fNo.of Ranges No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump_Number 1 Tons J KW No.of Self-Contained
ge
r.. Totals: 1 ; Detection/Alerting Devices
Municipal '
iu No.of Dishwashers Space/Area Heating KW Local Connection 0 Other
9 No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Data NWiof ng-Devices or Equivalent
Heaters KW } Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs 1 No.of Motors Total HP ;Telecommunications Wising:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of/Elec call Work: (When required by municipal policy.)
Work to Start: )/o) ci/ 3- 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 cov rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE , BOND ❑ OTHER [t (Specify:)
I certify,under KeekrA it that the itzfonnation on this application is tare and coiuplete.
FIRM NAME: 7 Lists Lane LIC.NO2 1 i3 7S, A
Licensee: South Yamoulh..MA 02664 Signature ,c ..� ...., *5-- w LIC.NO.:
(If applicable?ret1ffil4"!I41101gIfiritr line.) Bus.Tel.No.:78/Sid S'S 7f
Address: Alt.Tel.No.:
_
*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 one) 0 owner Fj owner's agent.
Owner/Agent
c;.,,,,ht,,..e •n_,___�_____ ,.. 1 PFRA,IIT RAW- SC I