BLDE-22-003388 Commonwealth of Official Use Only
nE. Massachusetts Permit No. BLDE-22-003388
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:12/14/2021
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) 233 CRANBERRY LN
Owner or Tenant Neil Thibodeau 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: Wiring for two HVAC units.
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
grad. 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. 2 Tonal No.of Alerting Devices
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 ❑ 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 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: Steven S Keith
Licensee: Steven S Keith Signature LIC.NO.: 10931
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:29 Kittredge Rd., Spencer MA 01562 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
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o� sa[tk aeeac�irwffa Official Use Only
II ,.' nem,' cc--�� Permit No. �
I .. �, 1"�"'w o` tins Serviced
lis
Occupancy and Fee Checked
.i -BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
A'PLICATION 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 INF,9RMATION) Date: 0-/)S/,(
City or Town of: Y,,,v",,,,,k To the Inspector of Wires:
v By this application the undersigned gives notice of his or her intention to rni the electrical work described below.
- Location(Street&Number) 233 Cr- k
Owner or Tenant A/c;L ;t o ice,) Telephone No.(/7 4.13 o73
Owner's Address
X Is this permit in conjunction wiff a building permit? Yes 0 No ;® (Check Appropriate Box)
V: Purpose of Building 124.5 .I,-4 Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
V New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
Number of Feeders and Ampadty
\/-\ Location and Nature of Proposed Electrical Work: ,n t l'/ e"','"'') 4, a .14.„4.., r1rn Jf mac...)
Completion of the following,table nt9,be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Celt-Snap.(Paddle)Fans No.of Til
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
oNo.of Luminaires Swimming Pool
Above
❑ AradIn- . ❑ No.Batteerry Units
ncy LigLighting�rndnits
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners 'NOV of Detection and
InitlattnA Devices
No.of Ranges No.of Air Cond. Ton' No.of Alerting Devices
No.of Waste Disposers
Heat Pump utmp Number T... KW No. n/AIertiSelf-Contained
nfi Devices
No.of Dishwashers Space/Area Heating KW Local 0 CoMun nnection 0 Other
No.of Dryers Heating Appliances KW y System's:*
ry No.of Devices or Equivalent
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP
TelecommunicationsofDevicesor qu vol
No.of Devices 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: /9-/j1 LI/ 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: INSURANCE ffr 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: LIC.NO.:
Licensee: Signature i' LIC.NO.: 16131 j
(If applicable,enter"exempt"in tis glicense number line.) Bus.Tel.No.:72r)-3 1 YVII
Address: t 74) (JAil. .' Si— STS /3G .S•„i-114Larss M.4- 472,3 Alt.Tel.No.:IDC-34.7 `/3?6---
*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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$