HomeMy WebLinkAboutBLDE-19-000820 c.ifit
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\ P Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-19-000820
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
IRev.1/071
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Cod; (MEC),527 CMI(,y2/p0
(PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:8/1 2018 ^ 1 t 3 � (
City or Town of: YARMOUTH To the aspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 75 CAPT STANLEY RD
Owner or Tenant BANKS CAROLYN E Telephone No.
Owner's Address 208 CARLSON LN,WEST BARNSTABLE,MA 02668
Is this permit In conjunction with a building permit? Yes ❑ No ❑ (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: Fum-AC replacement. Plug for OD WH.
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. grnd. Batter/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 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 _ _ _ _
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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: ALBERICO ELECTRIC-FOR SEASIDE GAS SERVICE
Licensee: Bruce Alberico Signature LIC.NO.: 11751A
(If applicable.enter"exempt"in the license number line.) Bus.Tel.No.: 5083624694
Address:20 Pint St,Yarmouth Port MA 02675 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) El owner El owner's agent.
Owner/Agent
Signature / Telephone No. PERMIT FEE: $50.00
(90/�` e f 201 f theg