BLDE-22-004608 Commonwealth of Official Use Only
1-4Massachusetts
Permit No. BLDE-22-004608
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
jRev.1/071
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:2/18/2022
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) 10 CORDICK RD
Owner or Tenant SCOTT JOHN W Telephone No.
Owner's Address SCOTT JULIE B, PO BOX 511, READING, MA 01867
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: Wiring for bathroom.
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 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. TotaloNo.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 ❑ 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 Signs 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: ADAIR MARTINS ELECTRICAN
Licensee: Adair Martins Signature LIC.NO.: 55688
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:215 Palomino Drive, Barnstable Ma 02630 Alt.Tel.No.: 5088156173
*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
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_ Permit No. ZZ. _' " 2ep"'.ni of Jw.*gawkedvcee; _-'
, BOARD OF FIRE PREVENTION REGULATIONSOccupancy
and Fee eked
[Rev. !/07] (leave blank)
• APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
MI work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
-� �(PLEASEPRINT IN INK OR TYPE ALL INFORMATION
II City or Town of: Date: C7 2
YARMOUTH To the Inspector of Wires:
y this application the undersigned gives notice of bis or her .tention to perform the electrical work described below.
Location(Street&Number) / _Aa, •L 1
Owner or Tenant i e til An4 .. Vol AIWA V
�� a Telephone No.
cC Owner's Address -j
N Is this permit in conjunction vii a building permit? Yes IC No ❑ (Check Appropriate Box)
lpurpose of Building p,n ' 1 Utility Authorizadon No.
xisting Service Amps / Volts Overhead
agglinigg 0 Undgrd 0 No.of Meters
Amps / Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampadty
Location and Nature of Proposed Electrical Work:
e, . t i i, to i id
Lb ,,tetton, the ollow : table m, be waived.
No.of Recessed Luminaires No.of 'o.o the I for o Wires.
C�-Suap.(Paddle)Fans Transformersota
A
No.of Luminaire Outlets Na of Hot Tubs
4' Na of Luminaires Generators KVA
F Swimming Pool ',d e 0 n- ❑ ELI
o 'mergency ' ;ng
No.of Receptacle Outlets Batte Unita
.,., No.of OU Burners
No.of Switches CEMIMM No.of Zones
No.of Gas Burners n a,
it.7 :122 0.Inttiatia Devices
No.of Alr Cond. °'
Tons No,of Alerting Devices
o.of Waste Disposers Teas
Totals: .'u._ ,_r ons !, o.o Va on:t a ,
No.of Dishwashers Detection/Alertia Devices
Space/Area Heating KW Local nn r ,
No.of Dryers Heating0 Connection 0 Otter
Appliances KWy c e ;
a o r `o.o No.of Devices or ' ,uivalent
Heaters KW o.o Data Wiring:
No.H dromassag S a Ballast No.of Devicesg�
Y e Bathtubs No.of Motors e ecommu ,or ,T u at
Total HPas f- .;
OTHER: No.of Devices or ' .
mt
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
(Wh
Work to Start: en required by municipal policy.)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the
the'licensee provides proof of liabilityincluding"completed o performance of its subs al work may issueentunless
insurance
undersigned certifies that such coverage is in force,and has exhibited proof of same to thee or substantial equivalent The
CHECK ONE: INSURANCE 0 BONDipermit issuing office.
I cerAtfy,ander the 0 OTHER 0 (Specify:)
FIRM NAME: •
pa andye r' of' rjwy,that the Information on this applkat9on is true and complete
Licensee: a t4, i / e
Irl. /.� j m LIC.NO.: 5 —�
al-applicable.ble.enter . 'in the lic a number in.l Ignature ► `' - LIC.NO.:
f s 1.o . z s Y , . 1,4' , ‘440 . Bus.Tel-No.:- - - I}3
"Per . L.c. 147,s.57-6 security •rk requires . oAlt.Tel-No.:
Mt3
required by
OWNER'S INSURANCE WAIVER: I am aware that the Licensee od rSafety"S"License: Lic.No.es not have the liability insurance coverage normally
w.
SI � la By my signature below,l hereby waive this requirement. I am the(check one III owner NI owner's a:errs
Owner/Ase
Telephone No. PERMIT FEE:$