BLDE-21-005514 \'l9\ commonwealth of Official Use Only
c
+ E Massachusetts Permit No. BLDE-21-005514
ilaABOARD 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:3/25/2021
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) 15 BELLEVUE AVE
Owner or Tenant Carolina Schoonyoung Telephone No.
Owner's Address 15 BELLEVUE AVE, SOUTH YARMOUTH, MA 02664-3101
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap.ropriate Bi
Purpose of Building Utility Authorization No. Pirizi lll���Existing Service Amps Volts Overhead ❑ Undgrd ❑ Y J
New Service Amps Volts Overhead 0 Undgrd ❑ i :/ ,or; ,/1 A
Number of Feeders and Ampacity r
Location and Nature of Proposed Electrical Work: Lights,fans, &switches.
it1
opgro,,,
Completion of the following table may be waive • •, cAr tf Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tof
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ElNo.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
i of
No.of Switches No.of Gas Burners No.tiatat Detection and
Initing Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump Number Tons KW
o.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal
Connection 0 Other:
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: r
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: EDWARD M LYNCH
Licensee: Edward M Lynch Signature LIC.NO.: 35609
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:25 WIDGEON LN,WEST YARMOUTH MA 026733818 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: $75.00 I
r
Q' '1 l.omnwnwea&(o f Maesachua stia Official Use Only
---.....%--- ''" :I
c� cc77 [n� Permit No. �1i� -(5-g-1 4
/1. o`. ire Jervu:ee Occupancy and Fee Checked
v--.....„,....... BOARD OF FIRE PREVENTION REGULATIONS [Rev.1107] (leave blank)
l ‘. APPLICATION FOR PERMIT TO PERFORM ELEC RICA WORK
All work to be performed in accordance with the Massachusetts Electrical Code ,, 527 CMR 12 ,I
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: , ir
City or Town of: YARMOUTH To the Inspect'r of Wi
By this application the undersigned gives no` of ' or her intention to perform the elec : work d • ribed below.
Locadou(Street&Number) 0 e I/ g P
+ ` J Owner or Tenant (r 0 G4 '"tD Telephone No.
Ne..............) Owner's Address 5 groif
Is this permit in conjunction with a building permit? Yes 0 No (Check Appropriate Box)
Purpose of Building UtilityAuthorization No.
�� Existing Service l t0 Amps /JO/ L(Volts Overhead❑ Undgrd No.of Meters
® New Service Amps / Volts Overhead E3 Undgrd 0 No.of Meters
`� Number of Feeders and Ampadty
Location Nature o posed Electrical �: .. , tit / /.f ! /
' A
'' t/i 9 kt5 / C il* /
/ Completion of thefollowingtable mag be waived by the In�s ector of Wires.
III No.of Recessed Luminaires No.of Cell.-Snap.(Paddle)Fans No.a of Total
® ce _Transformers KA
�1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
r1 r1
t. No.of Luminaires Swimming P� Above ❑ Iu- ❑ Bate Emergency Lighting
grad. mid. 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
iA
t t•° No.of Ranges No.of Air Cond. Tonst No.of Alerting Devices
Na of Waste Disposers
Heat Pump Number Tons KW No.of Self-Contained
F--- Tohls: `" Detection/Alertiu Devin ea
No.of Dishwashers S ace/Area HeatingKW Munidpa
p Local0 Connection 0 Olins'
,��.._ No.of Dryers Heating Appliances KW Security gystems:*
No.of No.of Water KW No.ofSiNo.of Data Wiring:Devices or Euivalent
_
Heaters ns Ballasts No.of Dvices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsWiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail IIfdesired,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: INSURANCES BOND 0 OTHER 0 (Specify:)
I cerdfy,under the pains and Ides of that the information on this application true and complete
FIRM NAME: / , /
LIC.NO.:
Licensee: ! /0„ n.th41i a 'j 1 Signature f / r LIC.NO.:3E(ga
Address: �. OW (1��y� • A epe ,i Bus.Tel.No.:
*Per M.G.L.c. 147,s.5,161,security requ' Department of SafEty"S"License: AIL L c.No.�� �/ _���~(1 ��
OWNER'S INSURANCE WAIVER: I am aw 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 III owner ■ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$