BLDE-21-004972 1\1 Commonwealth of Official Use Only
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Massachusetts Permit No. BLDE-21-004972
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:3/3/2021
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) 81 DRIVING TEE CIR
Owner or Tenant Paul Peterson Telephone No.
Owner's Address
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: Wire for basement&kitchen.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 24 No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 3 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 25 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 9 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 ❑ 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: ROBERT J CARREIRO
Licensee: Robert J Carreiro Signature LIC.NO.: 19861
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:2 RITA AVE, S YARMOUTH MA 026641976 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: $90.00
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Permit No.
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BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked
[Rev. 1/07]
(leave blank)
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 INFOR.M4TION) Date: 3 3/ (
City or Town of: YARMOUTH To the I ectejr of Wires:
By this application the t,mde:signed gives notice of his or her intention to perform the electrical work described below.
Location (Street&Number) r/ 77 l VJN6 72-=Z- Ci/ ke
Owner or Tenant "`7t Wit)/ •e--�c Zsd,e..7
Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes� ' � No 0 (Check Appropriate Box)
Purpose of Building /�fSi be' /,,/ Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ 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: Lr,,,k,E 15i sexce,tl i �
-PE�OV/ATdJA) r'S/7�Gs'/ icJ
Completion of the following table may be waived by the Inspector of fres.
No.of Recessed Luminaires No.of Cell Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- No.of L+mergency Lighting
ernd. arnd. ❑ Battery Units
No.of Receptacle Outlets A SJ No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches y No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total
Tons No,of Alerting Devices
No.of Waste Disposers Heat Pump I Number Tons H KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Loral❑ Municipal
Connection ❑ Other
No.of Dryers Heating Appliances , Security Systems:*
No.of Water No,of No.of Devices or Equivalent
No,of
Heaters ' Data Wiring:
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: 3/2../</ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE 0 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"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 ❑ (Specify:)
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:_!/ .q -, - J. (1,°1,f.,fejre,0 / c7QIr ref A-)
Licensee: /� / LIC.NO.:�`
/Id.geier- ( t om!Kg&l►�v Signature : LIC.NO..
(If applicable,enter"exempt"in the license tuber line.) f 4.----/ �
. Address: (2.0,AIX' /07d s, , RMollri-f iii Bus.Tel.No.:�D� 9¢-.�� g
J Per M.G.L. c. 147,s.57-61,securi work requires Department of Public SafetyAlt Lic.TelNo.:s 1� ,_�5-3�,
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability Lin.No.
� insurance coverage n�—
required by law. By my signature below,I hereby waive this requirement I am the(check one)❑owner ❑owner's agent
Owner/Agent
I Signature Telephone No. f PERMIT FEE: $ I