BLDE-23-001949 Commonwealth of Official Use Only
~ �. Massachusetts Permit No. BLDE-23-001949
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:10/12/2022
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) 8 PIERCE ST
Owner or Tenant BETH CIAM PA Telephone No.
Owner's Address 8 PIERCE ST,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 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Remodel. (Partially finished...May have to open walls.)
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- ❑ 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 ❑ 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 Ballasts Data Wiring:
Heaters Signs 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: MICHAEL F SIMONIS
Licensee: Michael F Simonis Signature LIC.NO.: 16862
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: PO BOX 1488, EAST DENNIS MA 026411488 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 my
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: $325.00
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i Occupancy and Fee Checked
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 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: S//7/2 a.
City or Town of: V,¢ sd/-'� To the Inspector of Wires:
(I 1.y t; is application the undersigned gives notice of his or her intention to perform the electrical work described below.
` J Location(Street&Number) ec r- T�
Owner or Tenant -� /-A C,.g—.,.-r, .f Telephone No.
Owner's Address _S'4,—r07-<._
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Buildings S,..1lr f„,_:./D✓e(L..- Utility Authorization No.
14 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
t
Number of Feeders and Ampacity
illLocation and Nature of Proposed Electrical Work:/?e,.94. ,i f,.,,r‘ .v�,r.,,, ,84...Se,, , Tlo��F,
/fr',g-G. ,9 A-z. ii,4-44, /rcri.. G�'✓.v/>/�#3� 'x'CZ.. ge.p r 1',0,1- , sook.,..e-e stkr,T
1 Completion of the followingtable may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No. f Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grad. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners Tio.I Detectionn and
Initiating Devices
No.of Ranges No.of Air Cond. Tons No.of Alerting Devices
No.of Waste era 'Beat Pump 1 Number Tons I 1 KW No.of Self-Contained
Disposers
Totals:I Detection/Alertln Devices
No.of Dishwashers Space/Area Heating KW Local 0 Connection iciPal 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water 'No.of No.of Data Wiring:
Beaten KW Signs Ballasts No.of Devices or Eq uivalent
No.H dromassa a Bathtubs No.of Motors Total HP TelecommunicationsNofDeicor Whin
y g No.of Devices Equivalent
OT tIER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of E ectrical Work: (When required by municipal policy.)
Work to Start: I' Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C VE GE: 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 covers a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) /,-t,o-•^e I -s
I certify,under the pains and penalties of pelury,that the information on this application is true and complete.
FIRM NAME:(—S/ems-sw$ •F/-C /G -�n c LIC.NO.:ofW P.1o2_
Licensee: 4.-, s Signature - LIC.NO.:�.3d�
(If applicable enter"exempt"in the license number line.) Bus.Tel.No.• - '86�7
Address:/�a. /34ak /94,PF 17. APe.s•si S' , 1- 1.0 •0/ Alt.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No.
CWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
rtqu ed by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent.
Owner/Agent PERMIT FEE:$ �.00
Signature Telephone No. 7
8/18/22,8:38 AM CAP List Portlet
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