BLDE-23-005692 .,k
`t� Commonwealth of Official use only
`; ` Massachusetts Permit No. BLDE-23-005692
' 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:4/13/2023
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) 40 WILFIN RD
Owner or Tenant COUTURES MANAGEMENT CORP INC Telephone No.
Owner's Address 42 PLEASANT ST, SOUTHAMPTON, MA 01073-9557
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 ❑ Undgrd 0 No.of Meters
New Service Amps Volts Overhead ❑ Undgrd 0 No.offs
Number of Feeders and Ampacity s a t,
Location and Nature of Proposed Electrical Work: Panel upgrade&remodel kitchen, bathroom, &offici (HOUSE 40-A)
a"'
Completion of the following tabitgootiketiotitiOetty the Inspector of Wires.
No.of Recessed Luminaires 10 No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets 5 No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 20 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 10 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges 1 No.of Air Cond. Total No.of Alerting Devices
Ton
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alertinc Devices
No.of Dishwashers 1 Space/Area Heating KW Local 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heate
of KW No.of No.of Ballasts Data Wiring:
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 0 S eci
fy:)
I certify,under the pains andpenalties o ( p
fperjury,that the information on this application is true and complete.
FIRM NAME: Timothy Crouss
Licensee: Timothy Crouss Signature
LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 16940
Address:PO BOX 178, FEEDING HILLS MA 010300178 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.:
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.
��G ( t/Z �9 : �S .€ — AII PERMIT FEE: $75.00 i
s10z,
" (_ommonweatth el��Iaddacettd Official Use Only
,, -x -�, 7� �/
' cc'�� Permit No.
= l 2epartment oi3ire Serviced
i{ ', 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: 41/7/2.3
City or Town of: coLAL 'L2N.00h, 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&Nu er) Ho A w •1 1,n R
Owner or Tenant (LIU"Li n. (VNcx/- ti ,v Telephone No.
Owner's Address Li a 1 c:.c.S o.A 4- Sr+ v ^ p y/`j �7l
Is this permit in conjunction with a building permit? Yes p� No� t�10 (Check Appropriate Box)
Purpose of Building `,v,,,e G k,AcA Utility Authorization No.
Existing Service f Cc Amps sri&/ di..10 Volts Overhead 4 Undgrd g 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:
r� � t1 �}/'C P.c�_W 2 ins c�1` Ky/i k.i,r,J r t3'i'L,POO11
W♦J 1.,%1�4 iy en f__ telw%-P tr 1 `cL S/0.CP 44 I c .A t.✓i I h ��.�A/ L LI G.-) 4�
Completion of the)ollowing table may be waived by the I'ector of Wires.
No.of Recessed Luminaires /a No.of Cell.-Susp.(Paddle)Fans No.of Total
Transformers KVA _
No.of Luminaire Outlets 5 No.of Hot Tubs Generators KVA
No.of Luminaires /O Swimming Pool Above ❑ In- No.of Emergency Lighting
grnd. grnd. 0 Battery Units
No.of Receptacle Outlets ,2 p No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches /0 No.of Gas Burners No.of Detection and
Initiating Devices
Tot
No.of Ranges l No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number.. Tons. . KW No.of Self-Contained
Totals:J �._. }""" ""' "" Detection/Alerting Devices
No.of Dishwashers r Space/Area Heating KW Local❑ Municipal
Connection ❑ � 1
No.of Dryers Heating Appliances KW Security Systems:*
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 Electrical Work: (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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE) BOND 0 OTHER 0 (Specify:)
I certify,under th ains and penalties ofpe ury,that the information on this application is true and complete.
FIRM NAME: ticIA CCA---Ot.tie IeCE ILA__ LIC.NO.: IC'! 10 A
Licensee:17t,,t 0-}ti N Ca..0k.),&S Signature �,�_____ LIC.NO.:
(If applicable,enter"e emj t"in the license num rli MAne.)
Address: I. fetiC'Jt.A�. 5 ' n Bus.Tel.No.: —
p , .311.°S.- Alt.Tel.No.:110 d yb d'Yo13
*Per M.G.L.c. 147,s.57-61,security wotk 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. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: S r75r cc
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