HomeMy WebLinkAboutBLDE-19-002790 a. to
Commonwealth of Official Use Only
IES; �_ Massachusetts Permit No. BLDE-19-002790
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/07j
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:11/7/2018
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertomi the electrical work described below.
Location(Street&Number) 28 VERMONT AVE
Owner or Tenant TUCKER REBECCA B TR Telephone No.
Owner's Address VERMONT AVE REAL ESTATE TRUST,28 VERMONT AVE,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters
New Service .Amps Volts Overhead 0 Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace burnt off secondary from private pole.
Completion of/he 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: Defection/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 Siens 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 ❑ BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties ofperfury,that the information on this application is true and complete.
FIRM NAME: James J Reilly
Licensee: James J Reilly Signature LIC.NO.: 16666
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 14 NORFOLK AVE, SOUTH EASTON MA 023751907 Mt.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 0 owner's agent.
Owner/Agent
Signature Q dd�CTelephone No.
PERMIT FEE: $50.00
0'. 'I( $1/g 6� ( .( innate re-D-620,1, iha ieg 6N //g)
v ,.til p9-ial Use OpJy
ik
`--'a Commonwealth of Massachusetts Permit No. 9- (V—'/ L'V
It VS'S Department of Fire Services Occupancy and Fee Checked
�e [Rev. 1/07]
BOARD OF FIRE PREVENTION REGULATIONS (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 11.7.18
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) 28 VERMONT AVE,
Owner or Tenant REBECCA TUCKER Telephone No:
Owner's Address 28 VERMONT AVE,WEST YARMOUTH,MA 02673
Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box)
Purpose of Building RESIDENCE Utility Authorization No.
Existing Service Amps Volts Overhead Undgrd No.of Meters
New Service _ Amps Volts Overhead Undgrd No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work REPLACE SECONDARY PRIVATE OVERHEAD
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 Luminarie 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 0 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 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 Inspections 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 pro-
vides 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 X BOND 0 OTHER ❑ (Specify° GENERA!.ACCIDENT INS 7/31/19
"Per M.G.L.c. 147,s 57-61,security work requires Department of Public Safety"S"License (Expiration Date)
I cert ,under the pains and penalties of perjury,that the information on this application is true and complete
FIRM NAME: REILLY ELECTRICAL CONTRACTORS,NC /RELCO LIC.NO.:
Licensee: TAMES T RFT!T V Signature 414t / LIC.NO.:A 16666
(If applicable,enter "exempt"in the license number line) Bus.Tel.No.: 508-771-2040
Address: 110 OLD TOWNHOUSE ROAD,SOUTH YARMOUTH,MA 02664 Alt.Tel. 508-400-8936
OWNER'S INSURANCE WAIVER: lam aware that the Licensee does nor have the liability insurance coverage normally required by
law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent.FAX-508-760-1425
Owner/Agent PERMIT FEE:
Signature Telephone No.