BLDE-21-007600 Commonwealth of Official Use Only
E` Permit No. BLDE-21-007600
_ Massachusetts --
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:6/30/2021
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) 38 TOURAINE WAY
Owner or Tenant DUBOIS JULIAN M TRS Telephone No.
Owner's Address DUBOIS FAMILY TRUST, 38 TOURAINE 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 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: Install NC&bring sun room up to code.
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 4 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 3 No.of Gas Burners No.of Detection and
Initiatinc 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/Alertinc 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. C /
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:) S1)g, 6 so t0 Cti7
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
Licensee: Matthew Gordon Signature LIC.NO.: 55830
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:22 Station Avenue,South Yarmouth Ma 02664 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: $250.00
sCE=3 :fr- 74(/7—t C� CCS ZZ �? . :.
/ii 7/7/17(
1 Commamesa&4///adaachudella Official Use Only
_` .� c� nn Permit No. ?_--1_7-766' )O
in ' 2epartnunl ofcc��ire Jervu:ea
I i`'a" Occupancy and Fee Checked
BOARD 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),527R 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 /2 / 21
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) 3 g -tOvlrp i v\e. 1N .. J;v-'(/1 h 4 r rye 0.> \
Owner or Tenant r::).1J ✓ Telephone No./i-//3Z '� Ful
Owner's Address o i t r;'eki-h e W C.t
• Is this permit in conjunction with a building permit? Yes R. No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
A 0
Number of Feeders and Ampadty /�
'location and Nature of Proposed Electrical Work: / h S•j )1,h'1 41 VI t1 it 6'in 0
at s 1, t `) i L`) .�tn t\ roc.)✓ - LIp 1 C c4e ,/1 K
Completion of the follolvinj table may be waived by the Inpector of Wires.
U i No.of Recessed Luminaires No.of CeiL-Snap.(Paddle)Fans „ i 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
g grad. ❑ In- ❑ Battery Units
No.of Receptacle Outlets `7 No.of Oil Burners FIRE ALARMS No.of Zones iN
z No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
i l? No.of Ranges No.of Air Cond. Tons No.of Alerting Devices :4-41\ N.'N's .)
No.of Waste Disposers Heat Pump Number Tons _ KW _ No.of Self-Contained N. rb
Totals: Detection/Alertin. Devices
No.of Dishwashers Space/Area Heating KW Local 0 Munidpal 0
Other
Connection ti\� /
No.of Dryers Heating Appliances KW Security Systems:* �1/`�
No.of Devices or Equivalent
No.of Water , 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:
l Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value.$El�tic Work: /tit0 (J (When required by municipal policy.)
Work to Start: / /2.34/2 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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE gl, BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties o perju that the information on this application is true and completes ,
FIRM NAME:1/Vl!�-?Th&v�J t;n f,.4(_ .v-\ LIC.NO.: 5 9��\ V
Licensee: X14114/1 e w ,e4Ner4 a IA Signature � 4. LIC.NO.:
(If applicable.ever"exempt"in the 4censenyptbei line.)
Address: (-,'(5 ("ct<4'i44 v) f i Vo Z 'r) ,1 ;) Bus.Tel.No.:SOs�G.<?Gc�()7�
Tel.No
*Per M.G.L.c. 147,s.57-61,se work requires Department of Public Safety"S"License: AIL Lic.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 the
Owner/Agent am (check one)0 owner 0 owner's agent.
Signature Telephone No. I PERMIT FEE:$
RECEIVEDI
JUN 29 2021
BUILDING
DEPARTMENT
By