HomeMy WebLinkAboutBLDE-22-001534 Commonwealth of Official Use Only
Massachusetts
Permit No. BLDE-22-001534
''-•' "� 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:9/16/2021
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) 34 NORTH MAIN ST
Owner or Tenant NEITZ RICHARD W Telephone No.
Owner's Address NEITZ ELIZABETH B, 11 GENERAL HOLWAY ROAD, SOUTH YARMOUTH, MA 0266' 0
Is this permit in conjunction with a building permit? Yes 0 No El (CI 'ropy' x)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 1111#110 le 411Ait
New Service Amps Volts Overhead 0 Undgrd 0 1 o
Number of Feeders and Ampacity ifr
Location and Nature of Proposed Electrical Work: Replace three electrical panels in root cellar and wiring coming ' • •., •i • • •
power back on in building as soon as possible.
Completion of the following table may V441 e''•'; : sector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.ofi otal
Transformers VA
No.of Luminaire Outlets No.of Hot Tubs Generators � KVA
No.of Luminaires Swimming Pool Above In- I: No.of Emergency Lighting
grnd. grad• 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
Initiatine 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 Ballasts Data Wiring:
Heaters Siens 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: 09/16/2021 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:) Liability insurance • 71L4—Gp(.I_0 Z��,S--
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: SIMON D BABA
Licensee: Simon D Baba Signature LIC.NO.: 53025
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:568 SKUNKNET RD, CENTERVILLE MA 026322738 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: $80.00
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