BLDE-22-003367 Commonwealth of Official Use Only
I
LIi Massachusetts Permit No. BLDE-22-003367
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) 182 OLD TOWNHOUSE RD
Owner or Tenant ANDERSON KENNETH A Telephone No.
Owner's Address C/O JOHN MCMULLEN, 186 SHEEP POND CIR, BREWSTER, MA 02631
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 ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Upgrade lighting „,�,r , `
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 27 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. 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 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: EVANDRO SOUSA
Licensee: EVANDRO SOUSA Signature LIC.NO.: 22277
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:202 N QUINSIGAMOND AVE, SHREWSBURY MA 01545 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$80.00
,CTt ei4 C zt-tPa 66 c,t e it Cer4vi6at 4g st 'a) To 86 ariktafelve0 Vzidlltigg
RECEIVED `
DEC 13 2921 ,alb 1 `fa .tts Official Use Only
1 ,, _ 3
• Permit No. j(.�i
DING DEPARTM{'*j ,, /3 �srvicrt
c
,,_�/ =OARD OF FIRE PREVENTION REGULATIONS [Rev.Occupan I/07]y and Fee Checked(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
G All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00
(PLEASE PRINT IN INK OR TY E ALL INFORMATION) Date: �1 '�a I �al
", City or Town of: Tin'
GZM 14- _M A To the Inspector of Wires.
s- By this application the undersigned gives ce of his or her intention to perfvuu the electrical work described below.
Location(Street&Number) j a, uib -Tomo wu Se Rh
o
vL Owner or Tenant C 0v N I E R-`O P S 1+3? Telephone No. ,3 0)4i 6 q00
•,,, Owner's Address
)� Is this permit in conjunction with a building permit? Yes ❑ No g (Check Appropriate Box)
0 Purpose of Building Cowl E RCA A L. Utility Authorization No.
1� Existing Service Amps I Volts Overhead El Undgrd 0 No.of Meters
/ Volts Overhead 0 Undgrd❑ No.of Meters
New Service Amps
e Number of Feeders and Ampacty
L Location and Nature of Proposed Electrical Work: • A..1-i& PGR.A - -tt) L -b
Q ..-ir.‘/ FkiC.Svi
1 (`�And A�c;t" office/ 'IJ use pt S I-(owi�20C
vl
J omplieon of tlte'Ja N k may be waived by the tnsector of Wires.
b: No.of Recessed Luminaires No.of Coil. o.of '
'(Paddle)Fans Transformers KVA
C; No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires .4- Swimming Pool Above ❑ In- ❑ Na of emergency Lighting
tired. itrnd. Battery Units
:i No.of Receptacle Outlets No.of O1I Burners
`` FIRE ALARMS ,No.of Zones
fNo.of Switches No.of Gas Burners No.Ini�tting DetectionDeand
vices
t=` No.of Ranges No.of Air Coed. Total
Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump 1 Number Tens KW No.of Self-ContainedTotals: }--�---� _ Detect1on/ Devices
No.of Dishwashers Space/Area Heating KWLocal
0 Counan tconst 0 OtherNo.of Heating KW Security Systems:*
D� or EquivalentNo.of Water orofNo.of Data Wiring:KW Signs Ballasts No. evices
or Eq uivalent
No.Hydro age Bathtubs No.of Motors Total HP Telecommunications W
No.of Devices or Eat
OTHER:
Attach ada5tional detail ffdesir+ed or as required by the Inspector of Wires.
Estimated Value of Electrical Work:$ ,01 j O5 Q (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and n
INSURANCE COVERAGE: Unless waived by the owner,no permit for the �° completion.k ass
the licensee provides proof of liability insurance includingperformance of electrical work may issue unless
undersigned certifies that such coverage is in force,and hs exhibited operation"oof coverage or its substantialin equivalent.eThe
CHECK ONE: INSURANCEproof of same to the permit issuing office.
I�fK,u�d� El BOND 0 OTHER 0 (Specify:)
FIRM NAME: pe naldes of that the non 1JI
®1�,5 A �C Y.L �n is true and complete.
�Ui N 0r�i0 AJ LIC.NO.:,- .
Licensee: R . SOUS(� Signature
afaPPlicabte, t"in t license LIC.NO.:S� � I
P number lure.) Bus.Tel.No.:c)I/I COL(5%
Address: 1-10iU(,t ST M AL A°12O V&I'H-►fl 4
*Per M.G.L.c. 147,s.57-61,security work req ires Alt.TeL No.:
Departrnent of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage
required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ow normally
Owner/Agent ❑owner's
Signature agent
Telephone No. I PERMIT FEE:$ ?, Q b 1