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Home My WebLink AboutE-19-3034 Commonwealth of Official Use Only d EEaMassachusetts Permit No. BLDE-19-003034 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/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:11/16/2018 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 clectricaFwork described below. Location(Street&Number) 130 SOUTH SHORE DR Owner or Tenant KOEHLER STEPHEN W Telephone Nr .>, Owner's Address 703 ASH ST, BROCKTON, MA 02401-5755 n Is this permit in conjunction with a building permit? Yes ❑ No El (Check Appropriate x „ { t� Purpose of Building Utility Authoriz ion No. 2306581 i Free Existing Service Amps Volts Overhead El Undgr 0 No.of Meters New Service Amps Volts Overhead ❑ Undgr 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Temporary service. 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- a No.of Emergency Lighting rnd. 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 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. FIRM NAME: BRUCE M ALBERICO Licensee: Bruce M Alberico Signature LIC.NO.: 11751 (If applicable,enter"exempt"in the license number line) Bus.Tel.No.: Address:20 PINE ST,YARMOUTH PORT MA 026751837 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 iect). ll//t4l/ / e • CnnatorweaS of Metesackalls Official Use Only mis 2.,44.,...././.71,„J Permit No. srviced • iOccupancy and Fee Checked _' BOARD OF FIRE PREVENTION REGULATIONS ,[Rev. WY] ' (leave blank) APPLICATION FORPERMIT TO PERFORM EL CTRICAL WORK All work to be performed in accordance with the Massachusetts Elecnica!Code C), 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: I ( ( f{ I ? City or Town of: YARMOUTH To the Insp ctor of Wires: By this application the undersigned gives notice o his or tin ition to perfoR the electrical work described below. . Location (Street&Number) r \-, d t-O t v Owner'orTenant Ske `0 .3 0 e n e a Telephone No. Owner's Address• �� Is this permit in conjunction with a building permit? Yes EVT‘I o Purpose of Building 0 (CheckAppropriate Bim) Utility Authorization No. Zl 0 G 5 g I Existing Service Amps / Volts Overhead 0 Und grid❑ No.of Meters — New Service _ Amps / Volts Overhead 0 Undgrd!T 0 No.of Meters Number of Feeders and Ampacity e, E Location and Nature of Proposed Electrical Work: '` n'\ ( Celt V l CE Completion\ `o'fthefolowrnl g7ablee may be waived bythe Inspector of Wires. No.of Recessed Luminaires No.of Cet7.-Susp.(paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs . Generators KVA N .of Luminaires Swimming Pool Abov ❑ d. BIn- 0 No,of Lmergency Lighting - grod. arnatteryUnits — No.of Receptacle Outlets . No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and • Initiating Devices No.of Ranges No.of Air Cond. Ton No.of Alerting Devices • No.of Waste Disposers Heat Pump I Number (Tons I KW No.of Self-Contained — Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingIC V' Municipal 1 10 Connection 0 Otho No.of Dryers Heating Appliances Kw Security Systems:* No.of Water No.of Devices or Equivalent No.of Heaters N° °f Data Wiring: 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 derfrM or as required by the Inspector of Vires. Estimated Value of Electrical World Work to Start: . (When required by municipal policy.)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 provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covers eisrin force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (BOND 0 OTHER 0 (Specify:) l tenth, under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: 1 1 Licensee: Signaler 1,I 2_ LIC. --' NO.: 11 (If applicable.enter"nempt"in the license number line) ' L Address: Bus.Tel.No...�� 01;:" J 'Per M.G.L.c. 147,s.57-61,securitywork requiresAlt Tel.No.:_p_� y_ Department of Public Safety"S"License: Lic.No. ZT0-- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner 0 owner's agent. , Owner/Agent Signature Telephone No. 1 PERMIT FEE:$