BLDE-21-006463 Commonwealth of Official Use Only
.-"�,,•A Massachusetts Permit No. BLDE-21-006463
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:5/7/2021
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) 8 Mt PAWKANNAWKUT DR
Owner or Tenant Dave Cox 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 garage.
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. Total No.of Alerting Devices
Tons
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 0 Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Siens 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 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: JOSHUA B DEJOIE
Licensee: Joshua B Dejoie Signature LIC.NO.: 53490
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 10 LEXINGTON LN,YARMOUTH PORT MA 026752437 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:$100.00
4 ur0.4 Stcn(u ri
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Official Use Only
Conursonweanh,el Maeguscisuseas
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- *. ,. BOARD OF FIRE PREVENTION REGULATIONS [Rev.
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
r---)P All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE illt,L INFORMATION) Date: 5---5
city or Town of: YG,c el 0 L.) 1.3.., To the Inspector of Wires:
..)
, By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
i:
-f- Location(Street&Number) 8 F0,0 1/..c,,moo,J .)-\-- 0 c
' Owner or Tenant 0(MI c, Co x Telephone No. '71'4
Owner's Address ?o%.W\ko-C\I\c'•-t- V‘)k
oe
Is this permit in conjunction with a building permit? Yes Dr No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps I Volts Overhead 0 Undgrd 0 No.of Meters
._c.d
New Service Amps / Volts Overhead 0Undgrd 0 No.of Meters
vd, Number of Feeders and Ampacity
--.. Location and Nature of Proposed Electrical Work: 6 c e_ co o c\\-\ 0\c.C_,
kr) Completion of the following table may be waived by the Inspector of Wires.
\it
No.of rotaT
tit No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
C. No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above r-1 In- I.-, No.or Lighti
-t. No.of Luminahes Swimming Pool and. u and. Li Battery Emergency ng units
::..J. No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
'No.of Detection anti
- No.of Switches No.of Gas Burners Initiating Devices
Total
11,1 No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
Heat Pump Number. T.smA. KW_ 'No.of Self-Contained
No.of Waste Disposers Totals: - '-- ''''- Deteetion/Alert4ig Devices
No.of Dishwashers Space/Area Heating KW I-A/cal 0 ICI:nanicillain 0 Clibl2'
nis:*Syste
No.of Dryers Heating Appliances
Kw Security No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
H
K W eaters Signs Ballasts No.of Devices or,Equivalent
No.Hydromassage Bathtubs No.of Motors Total IIP Telecoominunicadons Wirhig:
N .of Devices or Equivalent
OTHER:
Attach additional detail ifdesired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 01000 (When required by municipal policy.)
Work to Start: 5--2)_1 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 cov-yage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ler BOND 0 OTHER 0 (Specify:)
I certify,under the pains andEnaldes ofperjury,that the information on this application is true and complete.
FIRM NAME: Aoc---,5c,c\ 3-cl 5\To,-f•ce. LIC.NO.:
Licensee: '3"-os\\K)L. De.;To e._ Signature LIC.NO.: 53410--13
,, 4- —
(If applicable,enter"exempt"in the license mgoker line.) Bus.Tel.No.•
Address: A Ca?iTA:k 6.t\sk 6 tvx Alt.Tel.No.: 779 114 Dti 63
*Per M.G.L.c. 147,4.57-61,security work requires Department of Public Safety"S"License: Lie.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)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$