BLDE-23-003210 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE 23-003210
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:12/9/2022
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) 59 CAPT STANLEY RD
Owner or Tenant MONTANI FRANK L Telephone No.
Owner's Address 59 CAPT STANLEY RD, SOUTH YARMOUTH, MA 02664 ,
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 ❑ 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: Hybrid water heater.
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
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Heat Pump Number Tons KWNo.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water 1 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 ❑ 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 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
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S E PREVENTION REGULATIONS e .Occupancy/0 and Fee Checked
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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: et
City or Town of: YARMOUTH To the Inspector 4 )of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)(�(� j ft „(e)
Owner or Tenant FIigiq I._ 14 an*hri,' Telephone No. e-)0(, /' 9 a
Owner's Address (57J C : 12)-.6 ,9 L/C
Is this permit In conjunction MOS a building permit? Yes ❑ No WI (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Po„fp( do ,fit` (Tla.efn c ci 'w'r,w� c,,✓e/,n 5
0e. /I cW 1441 PJt^-e v.- iee'ha•csr
lr t Completion of the fol/owingdable my be waived by the Inspector of Wires.
U. No.of Recessed Luminaires No.otCell:Sos No.of 7 otal
,,r p.(Paddle)Fans Transformers KVA
` No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
Prnd. t;rnd. 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
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers 'Rest Pump Number 'Cons KW No.of Self-Contained
Totals:L ........ .......`.... ........._..)..........
1I I --. Detection/Alerthia Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municnnectionipal 0 Other
Co
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water 'No.of No.of Devices or Equivalent
HeatersNo.of
KWSigns Ballasts DatNo.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
u p/, n No.of Devices or Equivalent _
OTHER: A0(r<.�N''�- W c i it a"1 Y✓m
Q t/Vwt-f.! h <<I-lr rt%�l0/71Zc:aRM(-1 IN IT-
n Anbch additional detail if desired,or as required by the Inspector of Wires.
t.7
Estimated Value of Electrical Work: Q_QQ (When required by municipal policy.)
Work to Start: 0,70<_ 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 cetelfy,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: ("r.:v,(G... PI;etrdnt i MO..,v,rnti LIC.NO.:
Licensee: Signature�—
(Ifapplicable,enter"exempt"in the license number line.) a,..� LIl.No.'
Address:
Alt.Bus.Tel. o.•
'Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: c.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,1 hereby waive this requirement. I am the(check one)0 owner E owner's agent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE:$