BLDE-22-000817 or Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-000817
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:8/12/2021
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) 56 MICHELLES PATH
Owner or Tenant Heidi Hudson Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap A ox)61
Purpose of Building Utility Authorization No. /
Existing Service Amps Volts Overhead 0 Undgrd 0 ' # ..
New Service Amps Volts Overhead 0 Undgrd 0 #4• # of rn7'
Number of Feeders and Ampacity w ri
Location and Nature of Proposed Electrical Work: Installation of solar PV system. (25 Panels 8.125 KW) Q 4`r~s
Completion of the following table may be waive ` or of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 44.4
'`:�+'
Transformers A
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
Initiatine Devices
No.of Ranges No.of Air Cond. Totalo 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 ❑ 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 Ballasts Data Wiring:
Heaters Siens No.of Devices or Equivalent
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 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Lloyd R Smith
Licensee: Lloyd R Smith Signature LIC.NO.: 15688
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:30 1ST ST, MELROSE MA 021764010 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: $150.00
• " ' eornalossweata of Massoch ssils Official Use Only
I.
1tt_-q Apart./of�irs Permit No. ����-' �9
t;
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1107]
ti (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in acmnda to with the Massachusetts Electrical Code(ME 52 CMR 2A0L� I
(PLEASE PRINT IN INK OR TYPE INFORMA . Date: CJ
City or Town of: 1,fr u To the Inspector o ires:
By this applies the undersigned giv s�� a of his or intention to work�below.
Location(Street&Number) !C�' M I he 11
Owner or Tenant 1 H- i Telephone No.
Owner's Address "4r � i L Ve
Is this permit in conjunction nip a permit? Yes No ❑ (Check Appropriate Box)
Purpose of r � Utility Authorization No.
Existing Service Amps -\ / Overhead Undgrd El Na of Meters 1
New Service Amps / Volts Overhead❑ Undgrd El No.of Meters
Number of Feeders and Ampacity ,
Location and Nature of Proposed E ical Work: n _c `i I I •Z .'.�1 V
5( i/ ca(\( S , . 1 c--
Completion 4-thefallowing table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Cell.-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
Y,Ad- find. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.Initiating Devices
of Detection and
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
No.of Waste Disposers HeatTotals: Number'Tons KW__`No.Date of
Self-C�
No.of Dishwashers Space/Area Heating KW Localerlinkpevices
l 1-1 Municipal ca Lion ❑ Other
No.of Dryers Hating Appliances KW Security N of -or Equivalent
No.of Water KW No-of No.of Data Wiring-Heaters Signs B:Basts No.of Devices or Equivalent
No.Hydroniassage Bathtubs No.of Motors Total HP Telecommunications ring-
No.of Devices or Equivalent
OTHER:
(,;Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value o E ' 1 Work:% 2` j. (When required by municipal policy.)
Work to Start: - I Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including Meted operation"coverage or its substantial equivalent. The
undersigned certifies that such verage is in force,and has exhibited proof of same to the permit ironing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I certify,wader ,, - man of. , 7 that the information en , ' • i , • . is trine and c mpl
FIRM NAME: / p���/�V ,.�IL 100 er LIC.NO.: G
Licensee: ak AN`�1 f11It, '.? ., `►�i:T� �-� LIC.NO,_t_ f)"
(If applicabl4 . . "exempt"in the line.) 19 : , TeL No.-
Address: ( mit 'h�t Sh .151.1 el w t;� ) OAN-Tel.No.: LJ
*Per M.G.L.c. 147,s.5 -61,security work requires Department of Public Safety"S"License: Lie_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.
Own tune t I PERMIT FEE:$
Signature Telephone No.