BLDE-23-000601 Commonwealth of Official Use Only
. 11% Massachusetts Permit No. BLDE
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:8/4/2022
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) 4 THORNTON BROOK RD
Owner or Tenant MIKE SHEA Telephone No.
Owner's Address 4 THORNTON BROOK RD,WEST YARMOUTH, MA 02673
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 ❑ 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: Pool
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 Abovegrnd. ❑ In-grnd. B❑ No.ofatteryU Emnitsergency Lighting
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatine 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 ❑ Connection
Municipal 0 Other:
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 Signs 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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Joseph P Rose
Licensee: Joseph P Rose Signature LIC.NO.: 12339
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:25 Beverly Rd,West Yarmouth MA 026733559 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: $65.00
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AUG O 4 202 ' each of Maddarlsadoth. Official Use Only
, f� f';CD NG DEPART 4 ' , al° •}im Jervicse Permit No. "'Z3 '(� (
"''"_'` = ' 'EVENTION REGULATIONS Occupancy and Fee Checked
[Rev. 1/07] (leave blank)
Q APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(M ).527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:4//,/ . O? .
City or Town of: YARMOUTH To the Insc r of Wires:
By this application the undersigned gives fofice ofhis or her intention to perform the ec 'cal work descri below.
Location(Street&Number) LA �cl r'I'c--cm �C OC)k we-` t�G-eymg�1
Owner or Tenant iM IL. �),1G c 1` I'
Owner's Address• Telephone No.
• Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check
1 Purpose of Building Appropriate Box)
Utility Authorization No.
Existing Service Amps / Volts Overhead❑ . Undgrd❑ No.of Meters
J
DiszAcExist Amps / Volts Overhead El Undgrd❑ No.of Meters
Number of Faders and Ampacity
Location and Nature�f Electrical Work: r
m i a,-.t1 be i --L � ,Y-._P ?061 w ,�
Completion of the following table may be waived by the Inspector of lyres.
No.of Recessed Luminaires Na of CdL-Snap•(Paddle)Fans "No.of
Transformers KoVtalp
CI. No.of Luminaire Outlets No.of Hot Tubs Generators KVA
tic No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
'� No.of Receptacle Outlets mod' mod' ❑ Battery Units
Na of Oil Burners FIRE ALARMS 'No.of Zones
V'sNo.of Switches
4.
No.of Gas Burners 'No.of Detection and
t 1.1 Na of RangesInitiating Devices
No.i Air Cond. Total No.of Alerting Devices
Tons
Na of Waste DisposersHeat Pump'Number!Tons KW No.of Self-Contained
Totals: ��"�' "'"" Detection/Akrtin Devices
No.of Dishwashers Space/Area Heating KW Local❑ laIIIn
No.of Connection 0 OtherN
Dryers Heating Appliances KW Security Systems:*
Na of Water KW No.of Na of Devices or Equivalent
Heaters No.of Data Wiring:
Signs Ballasts No.o Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications W �
OTHER: Na of Devices or Equiva ent
Estimated Value of Electrical Work: Attach additional detail tf desired,or as required by the Inspector of Wires.
Work to Start: (When required by municipal policy.)
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 .1 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and pe ofpeyury,that the information on this application is true and complete FIRM NAME:
e. LIC.NO.:
Licensee:
� -'P - r (iej..-Sit./t% P LIC.NO.Ja of
(If applicablehgter"exempt"to he licviinumber l e
Address: t >c- ) . W,WA - 0�,0 /i Bus.TeL No.• �- 5�6
*Per M.G.L.c. 147,s.57-61,sakkurity work requires Department of Public Safety"S"License: AIL L c.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 III owner ■ owner's •±ent.
SOw attire ent
Telephone No. PERMIT FEE:$
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