BLDE-21-006084 o+_
C/1.0 Qtk Commonwealth of Official Use Only
if �,� Massachusetts
Permit No. BLDE-21-006084
�
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:4/21/2021
City or Town of: YARMOUTH To the Inspector of Wires: �Y
By this application the undersigned gives notice of his or her intention to perform the electrical work described below. /
Location(Street&Number) 56 MICHELLES PATH
Owner or Tenant Heidi Hudson 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 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Move receptacles&switches as needed.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires 3 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 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 ❑ 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 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 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:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 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
Queal
, rR 174 (i
0764{- I
Commonw.alii el/aaeachvAAHa Official Use Only
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�` /cc��� n Permit No. tCA`--2 d
ParfnrenE%,airs�7 srvasa
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 TYPE ALL INFORMATION) Date: IA I It I Z-o Z I
City or Town of: V) --t(,tit yv' lrVl`(' To the Inspector of Wires:
.4 By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
, Location(Street&Number) 'p (An..e I LP PG..
t�) Owner or Tenant 4 (,(,i ' .4,S U►^- Telephone No. t=j U ZSe 8-3�p
°s Owner's Address S t+ '.. ._
Is this permit in conjunction with a building permit? Yes 1 No ❑ (Check Appropriate Box)
t .Purpose of Building I V 1.ov-e -h l Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters (
New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
S Number of Feeders and Ampacity A&Mxii _
--.0 Location and Nature of Proposed Electrical Work: y em.) e.(,o e-- U� Levi--_t tti 1 Z S a.1 n eSt
t,' r{rha v&_ 0.4- dtsev L-i rw. aQ ).2.0 ( VI n _•G r -Fo(PAW-S F-ehe (r&o kJ-el( tci-kc ln..e,,.)
Completion of thefollowingtab/e may be waived by the Invector of Wires.
l.}. No.of Recessed Luminaires °', No.of Ca (Paddle)Fans No.of Total
i
-Bast. Transformers KVA
.1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA
'" Above In- No.of Emergency Lighting
-4- No.of Luminaires Swimming Pool Enid. ❑ mod, ❑ Battery Units
No.of Receptacle Outlets n0 i' No.of Oil Burners FIRE ALARMS No.of Zones
No.of Detection and
No.of Switches a. No.of Gas Burners Initiating Devices
II
' No.of Ranges No.of Air Cond. Tuns No.of Alerting Devices
No.of Waste Disposers HeatTotals:p Number Touts ......_KW_. No.of Self-Contained
Y.... Detection/Alertlng_Devices
No.of Dishwashers Space/Area Heating KW Local 0 l nnectlon 0 Other
No.of Dryers Heating Appliances ' SecNo.ofDevices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
Telecommindcations
No.Hydromassage Bathtubs No.of Motors Total HP No,of Devices or Equivalent
OTHER:
Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ik 200 (When required by municipal policy.)
Work to Start: i!I S t4 P 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 0 BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and`'penalties of perjury,that the information on this application is true and complete
.L�
FIRM NAME: •( lit k S Mk- LIC.NO.:
Licensee: Signature LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: Alt.TeL No.:
*Per M.G.L.c. 147,s.57-61,security work 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 by law. y my signature below,I hereby waive this requirement. I am the(check one owner ❑owner's agent.
Owner/Agent
Signature -r--60 --� Telephone No.51)V-ZV "gwl PERMIT FEE:S 1- —
lS*-1"1 � BLS-t- tU`i Yi tv be rt.e Lt,Se6