BLDE-22-005299 Commonwealth of Official Use Only .
1E _ Massachusetts Permit No. BLDE-22-005299
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:3/23/2022
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) 72 STUDLEY RD
Owner or Tenant MILLER JEFFREY D Telephone No.
Owner's Address MILLER CAROLYN E, 72 STUDLEY RD,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 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: Kitchen extension/remodel
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 12 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. grad. Battery Units
No.of Receptacle Outlets 15 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 8 No.of Gas Burners 1 No.of Detection and
Initiatinu Devices
No.of Ranges No.of Air Cond. Total
No.of Alerting Devices
Ti
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers 1 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 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:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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:$75.00
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MAR,. . Permit No. Z2` C
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B_IL u N c Y ENT T Occupancy and Fee Checked
By.--- 'L i 1 :• 'RD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
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 INF 9MATION) Date:
, ,City or Town of: /a r—Ia t 1, To the Inspector of Wires:
By this :... • .:;•, the .• . •• ed gives no:ce . his ore intention to the electrical rk described below.
S. / Q �f,�c-d' '
I er or Tenant f 1�Yh "� eS.ri l�9 /y�' 4///4-
Owner's
l�/��G Telephone No.,5 i i 1.�c i%j/i vie Y/i
Owner's Address ."?2 J%y�://% /et 50444/4 y4. eaA -
`i1 Is this permit in conjunction with a b, 1 ,, permit? Yea ❑JNo ❑ (Check Appropriate Box)
zTh Purpose of Building ;,.1 ,t, e'4'4:-,-t_ Utility Authorization No.
2v0
:v Existing Service Amps I Volts Overhead Undgrd❑ No.of Meters /
New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
Number of Feeders and Ampadty
N Location and Nature of Proposed Electrical Work: k,f fG y'e,-- ,,7 S/ :4 /ce,,,,c-yl
ti) ;o.of Recessed Luminaires I f No.of Ceil. - Fans • 'o.o o A
"Susp.(Paddle) Transformers KVA 4f4:.
.of Luminaire Outlets 0 No.of Hot Tubs Generators KVA F
i! Above In- lvo.of emergency Ligating ',
of Luminaire: Swimming Pool grad. ❑ grnd. ❑ Battery Units
of Receptacle Outlets / c No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
-` - f Switches j) No.of Gas Burners r Initiating Devices
11,1 N f RangesNo.of Air Cond. il
Total No.of Alerting Devices
U No.
Heat Pum Number Tons KW No.of Self-Contained
P ._ __..__._. _..__.___._....._..._.._
f Waste Disposers /�' Totals: Detection/Ales-tingDevtces
I. f Dishwashers 1 Space/Area Heating KWLocal 0 rection ❑ Other
of Dryers Seca Heating Appliances KW o.oSyste�nis:*
Nf Devices or Equivalent i�.
of Water , No.of No.of Data Wiring: �"
Heaters Signs Ballasts No.of Devices or Equivalent
.Hydromassage Bathtubs U No.of Motors Total HP TelecommunicationsNo.of Devices or Equivalent
—, _ ' •' Yronal detail i ea tiii MnivfMros.,;
Estimated Value of Electrical Work: (When required by municipal policy.)
._of '0_11 J a Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INS OVERAGE: 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 ❑ (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 LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.TeL No.:
Address: Alt.TeL No.:
'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE W VER: I am aware that the Licensee does not have the liability insurance coverage normally
required b 1 w. ntyls' below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent.
4.Al/ Telephone No.b % a 4441 PERMIT FEE:$ 75,OCD
CA/3-S-1(