BLDE-22-001779 0 t Commonwealth of Official Use Only
Permit No. BLDE-22-001779
Massachusetts
....II BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
1Rev.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:9/28/2021
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) 73 CHRISTMAS WAY
Owner or Tenant FOX PHYLLIS A Telephone No.
Owner's Address 73 CHRISTMAS WAY,SOUTH YARMOUTH, MA 02664
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
gNo.of Meters
New Service
Amps Volts Overhead ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Wiring of bedroom&bath addition.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 10 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 16 No.of Oil Burners
FIRE ALARMS I No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatine Devices
No.of Ranges No.of Air Cond. Total
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal
Connection 0 Other:
No.of Dryers 1 Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Ballasts Data Wiring:
Siens No.of Devics or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER: No.of Devices or Equivalent
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: JESSE R OTIS
Licensee: JESSE R OTIS Signature
LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 22145
Address:94 OLD CHATHAM RD, BREWSTER MA 026311979 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.:
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)) ❑ owner ❑ owner's agent.Owner/Agent
Signature Telephone No.
'PERMIT FEE: $75.00 I
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{— c� c� Permit No.
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t e Occupancy and Fee Checked
= .e BOARD OF FIRE PREVENTION REGULATIONS
,,a' [Rev. 1l07]
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(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C),5 7 CMR 12.00
(PLEASE PRINT IN INK OR TY ALL INFORMATION) Date: 2r
City or Town of: IUfrial To the Ins ecto of Wires:
By this application the undersigne gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) j Clko imc J
1,1.4y—
Owner or Tenant a/Ile f� Telephone No.
Owner's Address
Is this permit in conjunctio th a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building � Utility Authorization No.
Existing Service/CO Amps /20 /ZYO Volts Overhead 0 Undgrd[kr No.of Meters (
New Service Amps I Volts Overhead❑ Undgrd g 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: /{fit M.. of elicet /b_ 4
' Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 16 No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 5/ 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 /p 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. Total No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I t Tons 1KW No.of Self Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Municipal
�❑ Connection ❑ er
No.of Dryers / Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
No.of
Heaters KW 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 o Elec 'cal Work: �7/ (Whent)
required by municipal policy.)
Work to Start: Z Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE OV E: 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 ov rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:)
I certify,under the aims an enal ' o p )
L'_t{P f perjury,that the informs • non his application is true and completes
FIRM N • - �jf t 1 7-2/
r S ' LIC.NO.:
Licensee: r •P ,S Signature q
(If applicable, r."exem t"'n th ease tuber line.) LIC.NO.: �'3�} /
Address: Q� �� �m /Y7 f Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Publicbl Safety("S"License: Alt.LicTel.No.
5c��� �1
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 Owner/Agent one)❑owner ❑owner's agent.
Signature Telephone No. I PERMIT FEE:$