HomeMy WebLinkAboutElectrical Permit �� Commonwealth of Of�icial Use Only
Permit No. BLDE-16-002085
� Massachusetts
� BOARD OF.FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
ev.1/07
APPLICATION FOR PERI�IIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 1
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date•10/13/2015
City or Town of: YARMOUTH To the Inspector of Wires: O
By this application the undersigned gives no,ce o �s or er m en on o pe orm e e ec ica work described below. ,
Location(Street&Number) 51 MELGO LN
Owner or Tenant BONVINO LOUIS A Telephone No.
Owner's Address 5 FOUNTAIN ST,MILFORD, MA 01757-3707
Is this permit in conjunction with a building permit? Yes O No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service Amps Volts Overhead ❑ Undgrd O No.of Meters ',
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
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
rnd. rnd. Ba 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 '
Initiatin Devi es i
No.of Ranges No.of Air Cond. Total No.of Alerting Devices I�
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained � I
Totals: Detection/Alertin Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No. f D vices r E uivalent
No.of Water I{�, No.of No.of Data Wiring:
Heaters Si ns Ballasts No of Devices or E uivalent
No.Fiydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
No.of Devices or E uivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Esrimated Value ofElectrical 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 eachibited proof of same to the permit issuing office.
CHECK ONE:INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) '
I certify,under thepains andpenaltfes ofperjury,t/tat the information on this application is true and complet�
FIRM NAME: DAVID W SILVA
Licensee: DAVID W SILVA Signature LIC.NO.: 20608
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:55 THISTLE DR,CENTERVILLE MA 02632 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) ❑ owner ❑ owner's agent.
O�vner/Agent
Signature Telephone No. PERMIT FEE: $50.00
`, _. . r _ , - ::
�. , ,� �, _
s`
� � nr
�
�
. 15 2Q15 � ,
�
�
�.
, ..
, �