BLDE-21-006821 ff I Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-21-006821
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:5/24/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 233 CRANBERRY LN
Owner or Tenant LAWTON GARY R Telephone No.
Owner's Address LAWTON C M G R JR&K M, 15 WAYCROSS ST,WORCESTER, MA 01605
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: Recessed lights&fan
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 4 No.of Ceil:Susp.(Paddle)Fans 1 No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 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 2 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 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: DAVID M HAWKINS
Licensee: David M Hawkins Signature LIC.NO.: 31112
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 14 UNCLE JIMMYS LN,YARMOUTH PORT MA 026752252 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: $75.00
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Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS IRev.1/0'71
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APPLImilkwIrikOto tie pefibni.doRinPaccaltrefTwithTtheOmLIRFusetts ElecfriOFINCodeEL(ECTRICAL WORK
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
1
527 CM,R.12.00
Date: 5/ ."3 J I
City or Town of: V,09-1() Y)1 cu-i'H To the Inspector of Wires:
•Nz‘.2 ccitlierdois anp:(Tslicatr:en iintsetl:Nuiunders_m4betitioign.:d3\ngik)I3ves no'ciiirc(eriojf hisvor hi:7p\Mten;oni_toiljperformcthce,Le/ITectril4 calydepwioltkr:;descneft,a)Nnbedo.vibelow.
1 Owner's Address L. i_51.1)A 2‘0,..5_5 i IA,okc 'eSre:.-1- Mdf o1
Is this permit in conjunction with a building permit? Yes ka No 0 (Check Appropriate Box)
ct i Purpose of Building 3 5- -.74-56 ) rop,e.,14- U ,Authorization No.
Existing Service 2e..t., Amps /20 A9b Volts Overhead ali Undgrd El No.of Meters I
New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Mnpadty j -).-OC) .4-wr
Location and Nature of Proposed Electrical Work: A 44. Ae. r. p ,c s +L) to-Aby-)1E-_ picr),,'t,
vi.,4 Completion of the followingtabk mfg be waived by the Ivector of Wires.
Total
LI) No.of Recessed Luminaires /-1 No.of CeiL-Snip.(Paddle)Fans I °.°
-1Transformers KVA
=..
c'., No.of Luminaire Outlets No.of Hot Tubs Generators KVA
..*,
Swimming.,., Above 1.-.1 In- r-1 No.of tmergency Lighting
'it- No.of Luminakes .-uu. grad, L-I grad. 1.-1 Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
.-.
‘.1'.. ,-1 No.of Detection and
---- No.of Switches o.i., No.of Gas Burners
Initiating Devices
II
Total J No.of Ranges No.of Mr Cond. Tons No.of Alerting Devices
Heat Pump Number., Tons KW "No.of Self-Contained
Na.of Waste Divans Totals: - . -- Detection/Ale .1 Devices
No.of Dishwashers Space/Area Heating KW Local 0 Munan4;ti.Sion 0 Other
Security S=*
No.of Dryers Heating Appliances KW No.of or Equivalent
No.of Water No.of No.of Data'Wiring:
Heaters KW
Signs Ballasts No.of Devices or '. , -
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications No.of Devices or FA . t
OTHER:
/n Attach additional detail y'desityest or as required by the Inspector of Wires.
Estimated Value of Electrical Work -7 0'6) (When required by municipal policy.)
Work to Start: ''' "/ .5- 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-pge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE TWi BOND 0 OTHER 0 (Specify:)
/certlfr,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: xawja LIC.NO.:
Licensee: t- k" i (,./j h /-1,11,-)K))1!.$ Signature atior4-1 Are.d LIC.NO.: :3///a L-,--
(Ifapplicabk.enter"exempt"in the license number line.)
r .2- Bus.Tel.Na.: f n Li ara 06,.i3
Address: /LI uni c,bi'-' ,-I m Al‘z$ L.it- 1.4 19-414A0-114.PoOrls 5-Mt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security wat requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required bylaw. By my signature below,I hereby waive this requirement. lam the(check one)0 owner 0 owner's agent
Owner/Agent
Signature Telephone No. PERMIT FEE:$