BLDE-22-000193 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-22-000193
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:7/13/2021
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) 50 REFLECTION WAY
Owner or Tenant Bill Bryan Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No ❑ (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 lights in living room&bedrooms.
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
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/Alertine Devices
No.of Dishwashers Space/Area Heating KW Local 0 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 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties ofperjury,that the information on this application is true and complete.
FIRM NAME: JOHN B RAIMO
Licensee: John B Raimo Signature LIC.NO.: 18352
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:71 NEARMEADOWS RD,WEST YARMOUTH MA 026735009 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:$50.00
RECEIVED LU1/4)0>)
:' JUL 12 2021Co, ,nweatthof Maddachudaifd Official Use Only
'E`""'[�DING�DEPARTM tns, e/`� s' Permit No.
Z—®L93
- 'r�µi b ira arvusd
t -;.-° Ocupancy1/07) and Fee Checked
—..q
`' ' BOARD O - PREVENTION REGULATIONS
{Revc. (leave blank)
1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code( EC),5 7 CMR 12.00
ca (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 16.
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned Ives notice his o her intention to perform the electrical work described below.
Location(Street&Number) f
Owner or Tenant ` �.p
t Owner's Address (C l 1�" �ti1 , Telephone No. SA'A Co(a -.69 to
1 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
A Purpose of Building Utility Authorization No.
?� Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters
Number of Feeders and Ampacity
Lo tion and Nature of Proposed Electrical Work:
u L V C-1.)L Sus{aA( a . l ti -S
�e� Completion of the following fable my be waived vt by the Inspector of Wires.
11r,. No.of Recessed Luminaires No.of Cell:Sosp.(Paddle)Fans No.of Total
.„ Transformers KVA
CA No.of Luminaire Outlets No.of Hot Tubs Generators KVA
' No.of Luminaires Swimming Pool Above r-i❑ In- No.of Emergency Lighting
grad. grad. ❑ Battery Units
` No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners No.of Detection and
1.7 Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
No.of Waste Disposers Heat Pump ber ons J KW No.of Self-Contained
Tom:I ltu ' I Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal
Connection I-,
Other
No.of Dryers Heating Appliances KW Security Systems:1
No.of Water No.of No.of Devices or Equivalent
Heaters KW No.of Data Wiring:
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 lectr'cal Work: l,�j(3 (When required by municipal policy.)
Work to Start: 2 (a. Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO RAGE: 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 ❑ BOND 0 OTHER ❑ (S ci
I certify,under tlfiAains and penalties o erjury that the I ma n of th pl' ation is true and complete.
FIRM NAME: , i( L,L.c, �aLLSd't�C C
LIC.NO.:
Licensee: _ �ti,.,` Signa e
(If applicable,enter enrpt"in th li ense numb ine.) ` IA Bus.Tel.No:
LIC.NO.:-y�=-
Address: GY ` �i
*Per M.G.L.c. 14 ,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lie.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 owner owner's a ent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$ 6-6