BLDE-23-000894 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-000894
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
f 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:8/18/2022
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 electrical work described below.
Location(Street&Number) 66 DRIVING TEE CIR
Owner or Tenant KELLEY JOHN G JR Telephone No.
Owner's Address KELLEY NANCI M, 66 DRIVING TEE CIR, SOUTH YARMOUTH, MA 02664-2114
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 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install generator
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 1 KVA 14
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
Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers
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 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 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: Francis D Jones
Licensee: Francis D Jones Signature LIC.NO.: 13534
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:309 Neck Rd, Rochester MA 027701700 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:$80.00
l.ornmor2weaGt�o `_______:.
r,:*_.z /Y/ao6ac u6e Ee Official Use Only
tlN(t
�E}Ir'te arirzeni<ol cry PermitNo � —� �
; BOARD OF FIRE PREVENTION ION REGULATIONS Occupancy and F e Checked
•
APPLICAATION FOR PERMIT TO [Rev, I/07Jjeoo work -----
1 to be performed in accordance with the Massachusetts g ec�oa�Code�"�' �7 CMR ,0 WORK
(PLEASE PRINT.IN INK OR TYPE ALL,INFORMATION) Date; ( ) 527 12, 0
• City ot'TOM Of! � Pi1�y _�.
By this application the undersigned gives I ice of his or her nfient'
• l To the Inspector ofo Wires;
Location(Street& umber). (0 (p r perform the electrical work described below,
Owner or Tenant ��� .
Owner's Address _ �y � _l,,T�elephone No,
Is this permit in conjunction with a building � ` L co C�
this
Purpose of Building permit? Yes i No
(Check Appropriate Box)
Existing Service ----- Utility Authorization No,
Amps / Volts Overhead
h?e der ice Amps / Undgrd E.] No,of Meters
t Number of Feeders and Ampsit Volts Overhead ❑ Undgrd
❑ No.of Meters
c Location and Nature of Proposed EIectricaI Work; `--e"
00
�J No,of Recessed Luminaires Co��T leclon o the follorvin. table��z be waived b the Ins calm 0/'61�tres,
No,of Ceil•-Susp,(Paddle)Fans 1 o, o
No, of Lulninaire Outlets Transformers Va
No, of Hot Tubs ICVA
CIS Na of Luminaires Generators I{VA
No,of Lumina Swimming Pool .rn�]e 0 ^end. 0
"o.of mergency m i.ng
No,of Receptacle Outlets ' ' Batter Units
A 1 No,of Oil Burners
Q`� No, of Switches Etiatin
.) No,of Gas Burnrs et ion an
vi
No. Ranges oa - vices No,of No.of Air bond,
No,of Waste Disposers ' eat' um Tons No,of Alerting Devices
Totals; ,•,,,um,be;.,.,,,,.........................
Qns `.r .off"So7Zontiaine No, of DishwashersDetection/Alertin Devices
Space/Area Heating KW unici
No,of Dryers — Local 0• Connection ❑ Other
�o,.o rr Heating Appliances
ater �. KW ecur ity 'ystems;TM
Hectors KW o.o �o.o NO of Devices or E uiva lent
No,I�ydr omassage Bathtubs Si ns Ballasts Data Wiring:
No, of Motors' No,of Devicuivalent
OTHER; Total HP I eleco ofD 'patrons E.i; n ;
No.of Devices or E
• U1Va�ejlt
Estimated Value of Electrical Work; Attach addttionul detail , ` • °
Workat Start; (When required byIf ripa ec or as regiib'ed by the Inspector. IY1res,
WSURANCE Inspections to be requested in accordance withrMEC Rule 10,and upon completion,
INCOVERAGE; Unless waived by the owner,no permit for the performance of electrical work may
the licensee provides proof of liability insurance including"completed operation"coverage or
undersigned-oertifies that such coverage is in force,and has exhibited proof of same to thepermit issuing issue unless
CI-ILCIC ONE: INSURANCE its substantial equivalent, The
I cert¢J<unmet the pains and penalties 0 OTHER ❑ (Specify:) office,
., FIRM NAME; 0/ e f e1 siry,that the infornaattora on this application true and complete, j Licensee Q 1'1 t?j� �11� f :� a ��� 1
• (I,1'appltcable,enter "e by t' N the license rnnn er line, Signature ',a LIC,,IYQ�;
Address; v `' / u�,I zC,11To..,� �-
1'er M,G,L, c, 147,s,57.6I,security work requires bt
OWNER'S INSURANCE WAIVER; O BUs,Tel,No,;
pertinent o Public Safety« "Lice se:.Alt,Tel,N,'
I am aware that the Licensee does not have the liability y insurance coverage now rmal-1
required by law, By my signature below,I herebyLie,No,
Owner/Agent waive this requirement, I am the(check one
Signature ownery
0 owner's a:ent,
Telephone No, PIIT X'