BLDE-22-005332 or Commonwealth of Official Use Only
te.` � Massachusetts
Permit No. BLDE-22-005332
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:3/24/2022
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 el ctrical work described below.
Location(Street&Number) 1 2_ 1-up e(.
Owner or Tenant TYNDALL JEFFREY AND KARIN Telephone No.
Owner's Address 41'
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check.r
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: New residence
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 l
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
Initiatine Devices
No.of Ranges No.of Air Cond. TTotal No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 El BOND 0 OTHER 0 (Specify:) a6268. c—'7 j51/
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: MATTHEW D KLINE
Licensee: MATTHEW D KLINE Signature LIC.NO.: 53620
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 10 Nehoiden St, Harwich Port MA undefined 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:$180.00
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(( spartrrrsnf o tin ssrvicsd Permit No.
:b BOARD OF FIRE PREVENTION REGULATIONS
0APPLICATION FOR PERMIT TO p Occupancy and Fee Checked
Rev. Iro�� leave blank —'—'----
All work to be perfonned in acco PERFORM ELECTRICAL WORK
rdanae with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION)
� City or Town of: YARMOUTH To the Date: 3 Z3 J'ZZ
By this application the undersigned gives notice of his r her intention perform the elect ical Wires:
des r'
' Location(Street&Number) I Z T- a
described below.
Owner or Tenant
-r— o d;
Owner's Address Telephone No.
Is this permit in conjunction with a buildin
[�Purpose of Building g Permit. Yes No []
�,1 (Check Appropriate Box)
�/( Existing Service AmpsUtility Authorization No.
Volts
Overhead 0 Undgrd
Amps / ❑ No.of Meters
Number of Feeders and Ampacity Volts Overhead❑ Undgrd g No.of Meters �_
Location and Nature of Proposed Electrical Work::
yr, ✓ 2 c,e
0I` No.of Recessed Luminaires Cam.letion o the ollowin• table m
n.! naires No.of Ceil.-Sus be waived b the brs.ector o !fires.
No.of Luminalre Outlets P (Paddle)Fans ,°'° KVA
Q.
No.of Hot Tubs Transformers
4 No.of Luminaires Generators KVA
Swimming Pool cove n- 'o.o
No.of Receptacle Outlets red. ❑ nd ❑ mergency g ng
No.of Oil Burners Bane Units
No.of Switches FIRE ALARMS No.of Zones
t No.of Gas Burners
No.of Ranges o•o etec on an•
No.of Air Cond. ota Initiatin Devices
No.of Waste Disposers 'eat um Tons No.of Alerting Devices
p 'um�er
Totals: ........_.._....__.......
on ��
No.of Dishwashers "s "" o•o e - outs ne
Space/Area , Devices
pace/Area Heating KW
No.of Dryers 'un c
Heating Appliances Local 0Connection ❑ Other
'o.o "a er KW ecu ty ystems:
Heaters KW Bathtubs
o 'o.o No.of Devices or E•uivalent
No.Hydromassage Bathtubs sins Ballasts Data Wiring:
No.of Motors No.of Devices or E•uivalent
OTHER: Total HP a ecommun ca I ons " ring:No.of Devices or E•uivalent
Estimated Value of lectrical Work: Attach additional detail ildesired,or as required by the Inspector ofWires.
Work to Start: ZZ _. (When required by municipal policy.) res.
INSURANCE COVERAGE; Unlesspections to waived bathe ownere s nopermit d in accordance
with MEC
o Rule 10,
the licensee E CO proof of liability Un es insurance including oand upon completion.ayssu
undersigned certifies that such coverage is in force,and has exhibited proof of same to the p issuing work may issue unless
"completed operation"coverage or its substantial equivalent. The
CHECK ONE:
I ONE: the palINSURANCE
s andpenalties o De❑ OTHER 0 (Specify:) permitissuing office.
FIRM NAME:
fP !? ry,that the information on this application is true and complete.
Licensee: � I� ,
Licensee: e enter"exempt" Signature -...� LIC.NO.:
Address: 2 P Jh lrcensember Inc.) e� LIC.NO.: ��
*Per M.G.L.c. �`t sn.--')c,(-, �c LS
INSURANCE 1WAiyRRW Irk requires De Bus.Tel.Lic. o.. , —$ g 7 u
Department of Public Safety..S„License: Alt'Tel.No.:
OWNER'Srequired by law• am aware that the Licensee does not have the liability insurance coverage normally
Owner/Agent By my signature below,I hereby waive this requirement. I Signature am the(check one ■ owner ■ owner's a:ent.
Telephone No. PERMIT FEE:$