BLDE-19-001099 "'� a, �'.1 Commonwealth of Official Use Only
Ati_ Massachusetts Permit No. BLDE-19-001099
. j
�•:� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/07j
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:8/22/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice othis or her intention to perform the aclai work described below.
Location(Street&Number) 2 HIGHLAND ST
Owner or Tenant SHAH HELEN S TR Telephone No.
Owner's Address HELEN S 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 0 No.of Meters
New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install generator.
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 1 KVA
No.of Luminaires Swimming Pool Above ❑ In- a 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/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 Stens 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 Vdesired,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 El 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: DANIEL P DONNELLY ,
Licensee: Daniel P Donnelly Signature LIC.NO.: 50906
(If applicable,enter"exempt'in the license number line.) Bus.TeL No.:
Address:PO BOX 137.HARWICH MA 026450137 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
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at BOARD OF FIRE PREVENTION REGULATIONS O and Fee Checked
ev. 1//07]07] (leave blank)
APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All work ro be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: Q a/(1p
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of is or inter n to perform the electrical work described below. •
Location(Street&Number) u� sf" � / Arie w. �
.Owner Or Tenant 1}ral/, ( ty�r7�, Telephone No.
Owner's Address tSdfriQ6.—
__________
Is this permit in conjunction with a building permit? Yes ❑ No ® (Check Appropriate Box)
Purpose of Bailding Utility Authorization No.
Existing Servicet.)(r0 Amps tao /ayov°lts Overhead 0 Undgrdigi No.of Meters
New Service Amps / Volts Overhead 0 Undgrd 0 Nd.of Meters
Number of Feeders and Ampacity --
•
Loco tion and Nature of Proposed Electrical Work:
Completion of the follawfn [able mi,be waived by the Inspector of Wirer.
No.of Recessed Luminaires No.of Celt-Stun.(Paddle)Fans O•° Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA '
No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency[rghnng -
ar-nd. grad. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners No.of Detection and -
• • Initiating Devices
Total
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices .
•
No.of Waste Disposers Heat Pump!Number !Tons I KW No.of Self-Contained
2 Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW' LocalMunicipal
❑Connection 0 Other
No.of Dryers Heating Appliances
Y Security Systems:'
No.of Water No.of Devices or Equivalent
Heaters KW No.of No.of Data Wiring:
Signs
Ballasts Na of Devices or Equivalent
Q No.Hydromassage Bathtubs No.of Motors Total HP TelNo ofDeviatio or Wirinv:
vv No.of Devices Eq°ivZent
Ca OTHER:
Attach additional detail pedal-fret(or as required by the Inspector of Wires.
Nj Estimated Value of Electrical Work: (When required by municipal policy.)
Z� Work to Start -c),..?lef 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
V the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
C undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 7.1 BOND 0 OTHER 0 (Specify')
is f cent)", under the ns and penalties )
$�PerlTW1S that the injormatfon� on� this application is true and complete.
FIRM NAME: /�j}r(JL J-' UOXI4ELL�I � � " " r , LIC.NO.:
Licensee: 4S'4ME Signature !L 4il� •(/' LIC.NO.°�
(If applicable,enter"exempt"' the�license number l' s.Tel.No.;ly7�`..71(cl 97
Address: ,�a al's' !00. Oleg/ oabys- Alt.Tel.No.:
j Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. ------
Q OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragenormally
required by law. By my signature below, I hereby waive this requirement I am the(check one)0 owner 0 owner's agent.
t Owner/Agent
j Signature . Telephone No. I PERMIT FEE: $