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BLDE-21-005453 or Commonwealth of Official Use Only t`` Massachusetts Permit No. BLDE-21-005453 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:3/23/2021 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) 104 PLEASANT ST Owner or Tenant A.J. Luke Telephone No, Owner's Address 40 CROSBY ST,SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 ( S ; .4M,I r Purpose of Building Utility Authorizat'•n-= Existing Service Amps Volts Overhead 0 Undgrd & No.of Meters ' 'L'] 24 New Service 200 Amps Volts Overhead 0 Undgrd • No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring&service for modular home. 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/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 Data Wiring: Heaters 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 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. 'ji�� 30"i e� SS 7 CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) 6. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: PAUL J VIOLETTE Licensee: Paul J Violette Signature LIC.NO.: 20858 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 18 ANCHOR DR, FORESTDALE MA 026441822 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:$180.00 Perata, Q1260itottkko 41(C12-1 Ke--J ...---- ft ivyk. et m eE--- 17( _ C 1-h s( (74 ccs R1177J /7/�, t r _- lrommonwoo ofe/�//ads[[a7�chresstu ,. • rrffOi�cial Use Only it. �� •/ 1JaParfncent o�}ira Serviced Petmit No. L/� - �J 3 _ s BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked '�=-.. {Rev. 1/07] (leave blank) -- APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (MEC),s 7 CMR l 2.i)0 Cityor Town of: ��'� I YARMOUTH To the Inspector of Wires: By this application the t,mdersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /D y Pie c,,A_� : S�' Owner or Tenant L U A. STelephone No. Owner's Address - _S-A Is this permit in conjunction with a building permit? Yes No 0 (Check Appropriate Boz) Purpose of Building / 1-4/'/ - Utility Authorization No. ,j .' ,7 c �'_7 Existing Service Amps / Volts Overhead ❑_ Undgrd❑ No.of Meters New Service e Amps i ) f,) ej Volts Overhead i1 ❑ Undgrd Er- No.of Meters _____ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: C ..1-7-1 ., 4,4/l .,?0 Of (J,Z.7 S�;':u,c.t' -I- f��u,"4,...)w ,r1� o (- .:).3o) S Gi- MaJ_, l c./ )1-o / lo Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cal.-Susp.(Paddle)Fans No.of Total Transformer I{VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool mAbove ❑ In- No.of ll mergency Lighting = d. srnd. ❑ 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 Tons No.of Alerting Devices No.of Waste Disposer Heat Pump I Number I Tons I KW No.of Self-Contained Totals:I Detection/Alerting Devices S No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other ' No.of Dryers Heating Appliances KW Security S stems:* - - -- - v No.of Devices or Equivalent . No.of Water No.of -, Heaters KW No.of Data Wiring: NL Signs Ballasts No.of Devices or Equivalent Z No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - OTHER: No.of Devices or Equivalent _ Estimated Value of Electrical Work Attach additional detail if desired or as required by the Inspector of Wires. Work tStart: (When required by municipal policy.),i., o ` Inspections to be requested in accordance with MEC Rule 10,and upon completion. ,y 1 INSURANCE COVERAGE: Unless waiv d by the owner,no permit for the performance of electrical work mayissue � the licensee provides proof of liabilityiincluding"completed unless s undersigned certifies that such cove ge is in force, as exhibited proof of same to the permit substantial offic�valent, The 1 CHECK ONE: INSURANCE BOND ❑ OTHER. (2 (Specify.) ; I certify, wider the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: - 4 ` -,.I-r t Licensee: PG u / S / G LLIC.NO.: (� f�/ ' Signature ir-w-e q41` LIC.NO.: _ C:� (If applicable enterex .t in the license number line.) 1 , Address: ! a •tdet riA Bus.Tel.No.: 5L B 3p J Per M.G.L. c. 147,s.57-61,security work requires D �� _ No.. 4-r S 7S� qu Department of Public SafetyAlt TeL No.: — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage orm ally required by law. By my signature below,I hereby waive this requirement. I am the(check one o Owner/Agent ❑ writs ❑owner's a ent Signature 1.11 Telephone No. PERMIT FEE: $