BLDE-21-004035 Commonwealth of Official Use Only
•-•,iNit Massachusetts Permit No. BLDE-21-004035
� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
L 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:1/22/2021
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 192 SOUTH SHORE ,1
Owner or Tenant Horizon Engagement '
Telephone No.
Owner's Address 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 ❑ 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: Remodel ROOM#7
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 2 Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets 10 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches 3 No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total No.of Alerting Devices
Tons
Hof Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
Heaters KW No.of 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: 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
I certify,under the pains andpenalties o (Specify:)
f perjury,that the information on this application is true and complete.
FIRM NAME: Michael S Walsh
Licensee: Michael S Walsh Signature
LIC.NO.: 51043
(If applicable,enter"exempt"in the license number line.)
Address:36 BOSUNS WAY, MARSTONS MLS MA 026481015 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
signature below,I hereby waive this requirement.I am the(check one)) 0 owner ❑ owner's agent.
Owner/Agent
F ture Telephone No.
L IPERMIT FEE: $100.00 I
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CommorceveaCt4 oiaddach,udettd fficial Use Qnly
' M t c� cc77 Permit No. —1-1'
_=�1 department o/.`ire Serviced
-,_ - _ Occupancy and Fee Checked
,}, -«— BOARD OF FIRE PREVENTION REGULATIONS [Rev. y
`„; 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: \ t 1 t 1 Z 1
City or Town of: Y QC Mo v N. \ 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) I co_., S. S \o r t Pr V r %4- i* 1
Owner or Tenant ['*d r `Z,p r, 5..neJe�c�Q,,N►1,.� }• Telephone No.
Owner's Address S p.�e, J
Is this permit in conjunction with a buildin permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building A4.4 , Mo Utility Authorization No.
Existing Service j)d Amps 1t /2.o(0 Volts Overhead le..— Undgrd ri No.of Meters t
New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: ..1,4A to04. .-00 M 1t Z
t-`,
r e Q 4...rJ1 oAka S 1.Ait. IC,,icA,.., e Pt-1 Sir
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tf
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 I 0 No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
3 Initiating Devices
No.of Ranges No.of Air Cond. Total No.o f AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
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 Water No.of No.of No.of Devices or Equivalent
KW
Heaters 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: 1 c)^'►q kt 4.4.14.4...s.,sz t eT . 3 _p by 7 9.
Attach addition l detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: b oa' (When required by municipal policy.)
Work to Start: j 1 b/ Li Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE CO ERAGE: 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 Fir BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
�
FIRM NAME: c { S Ua1s. � c r LIC.NO.: 51 C T E
Licensee: Signature —i ) Lev14.1.j LIC.NO.: S 1 0 y 3 E.
(If applicable,enter `exempt"in the license nu er line.) Bus.Tel.No.. •633 5O1g
Address: p. 0 %o( 13 to 1MM4,e ,,.44 GZC V q Alt.Tel.No.: at 633•coot
*Per M.G.L.c. 147,s. 57161,security work 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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $