Blde-20-000046 v 6, 2" Commonwealth of Official Use Only
/111,6\ Massachusetts Permit No. BLDE-20-000046
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
JRev.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:7/2/2019
City or Town of: YARMOUTH To the Inspector of Wires:2, J 6 f �!�,,
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. [s'�CJ 7
Location(Street&Number) 108 FREEBOARD LN 4f 5(cc.a J
Owner or Tenant B Telephone No.
Owner's Address 108 FREEBOARD 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 boiler
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- CINo.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
Initiatine 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/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 Data Wiring:
Heaters Siens 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: Robert D Gauthier
Licensee: Robert D Gauthier Signature LIC.NO.: 27105
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:218 CAMELBACK RD, MARSTONS MLS MA 026481025 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
Olt -7X 44
,2VvtC,L .LOrt S uAec.r1 C
__ Commoruvsa of y7aac/ _ Official Use
J. .� c'l, xffs ,. Only
a1 = .2 eparfine,st al5i.re. Serviced Permit No. L-f1 o®4lo
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev. l/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:
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 el 'cal work described below.
lz;�_. .
Location (Street&Number) /0 8 ,�dL,Xe- 044 t �� r¢Y� /�r-
Owner or Tenant Jati/ti 1 i<6 �e�
`6 Telephone No.
Owner's Address �,�
Is this permit in conjunction with a building permit? Yes
❑ .No
. (Check Appropriate Boz)
Purpose of Building r) Utility Authorization No.
Existing Service 20O Amps /Zd/2 C Volts Overhead ❑ Und
grd❑ No,of Meters
New Service Amps / Volts Overhead❑ Undgrd--� ❑ No.of eters
Number of Feeders and Ampacity 0//7/1, c'- /9- d'e- l4 -c _
Location and Nature of Proposed Electrical Work. � �—
Completion of the following table may be waived by the Inspector o 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 Swimmia Pool Above In- No.of Emergency Lighting -
g mid ❑ ernd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS jNo.of Zones
4 No.of Switches No.of Gas Burners tal No.of Detection and
�jToInitiating Devices
• No.of Ranges No. of Air Cond. Tons No.of Alerting Devices
\ No.of Waste Disposers Heat Pump)Number I Tons I KW No.of Self-Contained
Totals:II l Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW• Local❑ Municipal
Connection ❑ °ther
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters ' 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: _
r- 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: 7---Z-�/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAG : Unless waived by the owner,no permit for the performance of electrical work may issue unless
N the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
u undersigned certifies that such cove a is in force,and has exhibited proof of same.to the p 't issuing office.ONE: INSURANCE [v]BOND 0 OTHER 0 (Specify:) /-71A3, 4
I certify, under the p 'ns and pen ' s 'ury,that the information on this application
FIRM NAME: f PP cairon is true and complete.
��.1i� L't- ' ' .0v� l LIC.NO.: a-7/C �k_
Licensee:
14 Signature LIC.NO.:
(If applicable, ri'ex pt"in 1,�e ese ben " Iv 4 Address: (j'y W,t � , Bus.TeL No.: -��Yi
C f /7,- iit Tel.No.:
,, *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety" L' Lic.No.
— OWNER'S INSURANCE WAIVER I am aware that the Licensee does not h4 ilisurance coverage normally
O required eAgent by law. By my signature below,I hereby waive this requirement I am the(check one)El owner 0 owner's agent.
I Signature Telephone No. [PERMIT FEE: $ 6-0) " 1