BLDE-23-003682 Commonwealth of Official Use Only
1 Massachusetts Permit No. BLDE-23-003682
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:1/6/2023
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) 583A FOREST RD UNIT 1
Owner or Tenant MIKAETY RODRIGUES Telephone No.
Owner's Address
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: Make corrections and permit un-permitted &un-inspected work.
Completion of the following table may be waived by the Inspector of Wires.
No.of Total
No.of Recessed Luminaires No.of Ceil.-Susp.(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
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Gas Burners No.of Detection and
No.of Switches Initiating Devices
No.of Air Cond. Total No.of Alerting Devices
No.of Ranges Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers Totals: Detection/Alerting Devices
Municipal No.of Dishwashers Space/Area Heating KW Local ❑ Connection
❑ Other:
HeatingAppliances KW Security Systems:*
No.of Dryers PP No.of Devices or Equivalent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
Telecommunications Wiring:
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
required bymunicipal policy.)
Estimated Value of Electrical Work: (Whenq p p y.
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: Marcelo R Soares LIC.NO.: 13036
Licensee: Marcelo R Soares Signature
Bus.Tel.No.:
(If applicable,enter"exempt"in the license number line.) Alt.Tel.No.:
Address:53 FALMOUTH SANDWICH RD, MASHPEE MA 026494307
*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. I
Owner/Agent 'PERMIT FEE: $300.00
Signature Telephone No.
1 Common.weatth o/Memaachudalid Offii„.,=°kr,
Permit No. (%2 cial Use�j Only" l c ' 1 '
,df�; s/oarlmsnl oc-�ir�} a �srvu sd
1y , Occupancy and Fee Checked
BOARD OF ARE PREVENTION REGULATIONS {Rev. Il07] (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
�i (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: j( I el,", '7")-j
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.
R.y Location(Street&Number) 5i3 A=(.,rL-'S-, lz 0Li;,./Li 1,
i Owner or Tenant t t t JY�),; ;_v;)ti,tti,t;X:"< Telephone No. '
M Owner's Address p �� 1
G Is this permit in conjunction with a building permit? Yes ❑ No
❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd E No.of Meters
NNew Service Amps / Volts Overhead
❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 2.(-vnvvt ,,•r,,-) i)eq..tert to 1101 71,c ti, C,,,, ) .kil0 t(
a s 7 vtl l:. ) l-t ors
s u kr
Completion of the followin table may be waived by the Ins�ector of Wires.
th No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1No.of Total
!Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Wit:` No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
grad. grnd. 0 Battery Units
�t No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones
.,— No.of Switches No.of Gas Burners 'No.ofbetection and
is — , Initiating Devices
No.of Ranges No.of Air Cond. Tons) No.of Alerting Devices
No.of Waste Disposers Heat Pump I limber 'Irons KW No.of Self-Contained
Totals:L Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipalonnection 0
Other
C
No.of Dryers Heating Appliances KW Security Systems:*
No.of
No.of Water a KW No.of No.of Data Wi ingvices or Equivalent
HeatSigns Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications bung:
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: 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 Ell BOND 0 OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: l‘"G-t ti-Lo f-- ` 9Mei k,f,-G Oi!rr.) LIC.NO.: (12.JlI(, 15
Licensee: Signature ff 2 LIC.NO.: 2 /L
%49
(If applicable,enter"exempt"in the license number line.) �,� L
Address: v Bus.Tel.No. 174 `ii✓!� E [_
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lie T .NNo
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)1❑owner ❑owner's agent.
Owner/Agent I
Signature Telephone No. l PERMIT FEE:$