Blde-20-001023 a'
Massachusetts
al Commonwealth of Officialati_A Use Only
Permit No. BLDE-20-001023
�E
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•8/26/2019
City or Town of: YARMOUTH To the Insp ctor of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work describe b ow. 8-
Location(Street&Number) 35 AMY LN "/
Owner or Tenant Telephone No.
Owner's Address 35 AMY LN,YARMOUTH PORT, MA 02675
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: Replacement HVAC.
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 1 No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices
Tons
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
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 ❑ OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: ANDREW G THOMAS
Licensee: ANDREW G THOMAS Signature LIC.NO.: 22152
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:7 ECHO LN,CHATHAM MA 02633 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: $50.00
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a I Official Use Only
Commonwealth,o��a�aac�u�ette
Permit No. w---U31
P. -v .2epartment o/.ire Services
Occupancy and Fee Checked ��
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to he performed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Au 5 a1, d014
City or Town of: ()Att`oi,I I, To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street& Number) 3 5 leilikiK.1 - AA 47 `1 11
Owner or Tenant 70"n S c h 2' V<-1lr Telephone No.
Owner's Address 3 S A 5 l v.._
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building f:3 )t� i y ( Utility Authorization No.
f. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
* -- Niav.$ierv►ce Amps / Volts Overhead n Undgrd n No.of Meters
i, ` c-" N nb(er of Feeders and Ampacity
0'' " c=,, L eation and Nature of Proposed Electrical Work: F'. t rl cc-tn.( n. AL - Tvrnk I 't
J ',' Completion of the,following table may be waived by the Inspector of Wires.
M `D No.of Total
1 16,
2 Dom t'. 4Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
, t NV..t►f Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires SwimmingPool Above ❑ In- No.of Emergency Lighting
grnd. grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
of
No. of Switches No.of Gas Burners No. InDeteitiatinnggon and
In Devices
No. of Ranges No.of Air Cond. 1 TotalTons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
I Totals: Detection/Alerting Devices
No. of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No. of Motors Total HI' Telecommunications No fDeDevices
or Wiring:
g No.of Devices Equivalent
OTHER:
qq Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ii 0 50.o (When required by municipal policy.)
Work to Start:Av c ),) e)011 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 coy rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONIs: INSU RANCE] BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjmy,that the information on this application is true and complete. /�
FIRM NAME: 1 'S LI, (,i f.l,4I $it� In(-r L LIC.NO.: ao� l �a'�'1
Licensee: �'h CI((1 II"' 1L) 4--( Signature [► LIC.NO.:
flt'applicuble, enter 7exenrpt"in die license n nrber line.) Bus.Tel.No.:
Address: ( c%n st C l't^ t t+C r% Alt.Tel.No.:
*Per M.G.I,. c. 147,s. 57-61,security work requires Department of Public Safety"S"I,icense: Lie.No.
OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not hare the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ I
Signature Telephone No. 1