HomeMy WebLinkAboutBLDE-19-003111 cor
Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-19-003111
�"= 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:11/20/2018
City or Town of: YARMOUTH To the Inspector Wires:
By this application the undersigned gives notice of his or her intention to pertonn the electrical work described belgw.. n y q.2„
Location(Street&Number) 17 WILD WOOD PATH IC/' �c7i' r/J
Owner or Tenant DINATALE MARY A Telep one No.
Owner's Address ROUSSELL P M&SPRY A D,340 POND ST,WEYMOUTH,MA 02190-1330
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: Septic pump&alarm.
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 0 . 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
Initiatin¢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 1
Totals: Detection/Alertin¢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 Stens Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors 1 Total HP Telecommunications Wiring:
• No.of Devices or Equivalent
OTHER: .
Attach additional detail ifdesired,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: JOHN M PIMENTAL
Licensee: John M Pimental Signature LTC.NO.: 27968 •
(If applicable.enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 1158 E FALMOUTH HWY, EAST FALMOUTH MA 025365455 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: $100.00
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