BLDE-19-002060 0
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Commonwealth of Official Use Only
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Massachusetts Permit No. BLDE-19-002060
BOARD OF FIRE PREVENTION REGULATIONS i Occupancy and Fee Checked
JRev.l/071
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:10/9/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. l
Location(Street&Number) 2 HIGHLAND ST
Owner or Tenant SHAH HELEN S TR Telephone No.
Owner's Address HELENS SHAH REVOCABLE LIVING TRUST,2 HIGHLAND STREET,WEST YARMOUTH,MA 02673
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: Install receptacles as needed.
l
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddie)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs . Generators KVA
No.of Luminaires Swimming Pool Above 0 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
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 0 Municipal 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Watery 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
OTIIER:
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: Neil Schoener
Licensee: Neil Schoener Signature LIC.NO.: 13949
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:44 TRADERS LN,W YARMOUTH MA 026733333 Mt.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:$75.00
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g , Commonwealth of///adeachiwelto
J'tilt eye e�
El .UrparGntnt o f.tiro&n'ked Permit No.
fa Occupancy and Fee Checked
•NS
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 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 12.000
(PLEASE PRINT IN INK OR TYPE I I INFORM TION) Date: /0 ' ' 7-1g(
City or Town of: y9-2!1Z ovni To the Inspector of Wires:
By this application the undersigned g. es notice of his or ter intention to perform the electrical work described below.
Location(Street&Number) oZ /7 I .e( h 14,106 .STS 14, `� AQo�'t0v7Ti
Owner or Tenant N .n-CJesemi/ id Telep lone No.
Owner's Address •
Is this permit in conjunc,�ti with a building permit? Yes 0 No (Check Appropriate Box)
Purpose of Building jrdilii cern;eta, Utility Authorization No.
Existing Service_ Amps I Volts Overhead 0 Undgrd❑ - No.of Meters
New Service _ Amps / Volts Overhead 0 Undgrd ❑ No.of Meters _
Number of Feeders and Ampaclty
Location and Nature of Proposed Electrical Work: op phis W heftei .t a "
VI Completion of the allowingtable m be waived by the Inspector of Wires.
Total
Ui No.of Recessed Luminaires No.of Ceil:Sas . Paddle Fans No.ofEVA
P (Paddle) Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators
KVA
Ci
No.of Luminaires Swimmin Pool Above ❑ In- ❑ No.of Lmergency Lighting
g grad. grnd. Battery Units
"! No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners Na.of Detection and
Initiating Devices
l
11.1 No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump NuK
mber_Tons _ W No.of Self-Contained
P Totals: — Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ MunicinnectS pal 0 Other
C _
No.of Dryers Heating Appliances KW SecuriNo oSystems:*
Devices or Equivalent
No.of Water iRV No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalentg _
No.Hydromassage Bathtubs No.of Motors Total HP 1 eiNo of Devic soor Wiring:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: -*7-00 0 (When required by municipal policy.)
Work to Start /0 -*s--) FInspections to b quested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waiv y the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability i ranee including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such cov a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) p
I certify,under the pains pr{d penalties of perjury,that the infarmatio on this app!i lion is true and complete/113 9 l t!I
FIRM NAME: rLitt.i SGHo-erlc LIC.NO.:
licensee: Signature 1 LIC.NO.:
(If applicable, gs4r�rpr�' ' 1lhe�/' m b r11pa Bus.TeL No: Q / 7
Address: �I r` T � �/-LS/�a�-�i9v//1 Alt.Tel.No.:�Qt� '701�� /
*Per M.G.L.c. 147,s.57-61,security work requires Dep rtment 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)0 owner 0 owner's agent
Owner/AgentPERMIT FEE:$
SignaatureureTelephone No.