BLDE-22-001019 Commonwealth of Official Use Only
Massachusetts
Permit No. BLDE-22-001019
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:8/23/2021
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) 8 SHADY REST DR
i
Owner or Tenant Allison Voelger Telephone No.
Owner's Address
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 ❑ Undgrd 0 No.of Meters l'
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Remodel bathroom I'
I
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
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 0 Other:
Connection `>1
No.of Dryers Heating Appliances KW Security Systems:* C.
No.of Devices or Equivalent co
No.of Water KW No.of No.of Ballasts Data Wiring: M
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 of perjury,that the information on this application is true and complete.
FIRM NAME: WILLIAM C FLIGG
Licensee: William C Fligg Signature LIC.NO.: 12584
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 FREEMAN RD,YARMOUTH PORT MA 026752304 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) ❑ owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $75.00
Esuceo, ril i __
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Commonwealth o/!/la44achusett. Official Use Only
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;_'Mli,—.. t c] Permit No.
G ==I�1!_ epar meet o/.`ire�ervice6
MILT 1 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),527 CMR 12.00
(PLEASE PRINT IN INK OR E ALL INFORMATION) Date: X 23-1,/
City or Town of: G jt'iq To the Inspector of Wires:
By this application the undersigned gives no a of his o her intention to perform the electrical work described below.
Location(Street&Number) Sia r�sT - d t—t'V,-(
Owner or Tenant P 1 (5." \I 0,1 Air Telephone No. % ;
Owner's Address SG 7f_at,/ 79(/
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building ,nc4,l ccW I 1 i (4 Utility Authorization No.
Existing Service p 0Ci Amps 176 i`..y1) Volts Overhead L Undgrd❑ No.of Meters J
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: a L ,L O IA 4 ,
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 Di In-
❑ No.of Emergency Lighting
grad. grad. 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
Initiating Devices
Tot
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipalonnectio n 0 Other
—
C
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of WHeaters ater KW No.of No.of Data Wiring:
Signs Ballasts i 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: GE, 1 )q ?.I (When required by municipal policy.)
Work to Start: 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 cov9age is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 101 BOND 0 OTHER 0 (Specify:)
I certify,under the pins and penal es of perjury,that the information on this application is true and complete.
FIRM NAME: (A/t i I I , C 4-t, cI,e C\&� \ LIC.NO.: 17i���
Licensee: 1 1
Signature LIC.NO.:
(If applicable,enter "exempt"in the I se number line.) C�
Address: Bus.Tel.No.: /Y Ct 1T(-j i V V7
Tel.No
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.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 am the(check one)0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: $