HomeMy WebLinkAboutBLDE-19-002304 a r
Commonwealth of Official Use Only
ite Massachusetts Permit No. BLDE-19-002304
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
Rev.l/07
APPLICATION FOR PERMIT TO PERFORM ELECTRIpRIfyf E D
All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CM' 12.41
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:4e40
City or Town of: YARMOUTH To the Inspector of Wires: OM"
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) 59 WHITE ROCK RD BUILDING DEPT.
Owner or Tenant FLAHERTY PAUL B Telephone No. Illailall
Owner's Address FLAHERTY MARY P,59 WHITE ROCK RD,YARMOUTH PORT,MA 02675-2314
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: AC replacement
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 ❑ Iq- ❑ 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 ❑ 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 - Sians 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: 10/25/2018 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: 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) 0 owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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