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Home My WebLink AboutBLDE-19-1624 ) w Commonwealth of OfficiaL Use Only Massachusetts Permit No. BLDE-19-001624 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] 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 ININK OR TYPE ALL INFORMATION) Date:9/18/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of hu or her intention to perform the electrical work described below. Location(Street&Number) 141 CENTER ST Owner or Tenant HAMMOND STEPHEN R Telephone No. Owner's Address HAMMOND MARY M, 141 CENTER ST,YARMOUTH PORT,MA 02675 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: Bedroom&bath room addition. 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 Ab ❑ In- 13No.of Emergency Lighting grnove d. Md . Battery Units 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. 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 Stens 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 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 r l.ommomesa&ot11t/assac tie caul Use On cc77�� cc77� pp .4 - ( ete 1J4parlme�o/yin..7teekes Permit No. .10* OccupancBOARD OF FIRE PREVENTION REGULATIONS cv. 1/07] and Fee Checked ev. 1/07] (]cave blank) o ZElectrical FORPERMIT TO PERFORM ELE TICAL WORK All work be performed in accmriance with the Massachusetts Eleccal Code CME 527 12.00 Ill ar, g ('LEASE PRINT ININK ORTYPEALL INFORMATIONJ Date: (/. > W o ( CE City or Town of: YARMOUTH To the Inspec r of fres: LL! Lc.t Le this application the!alders-ivied gives notice of his or her intention to perform the electrical work described below. "1 m •'•cation (Street&Number) 1�1 ' C JJ-'C C� �T V ! , z a • er'orTenant T�VE Nl\`MYYI on O Telephone No. I - a wner's Address IX 5 x I this permit in conjunction with a building peni o Yes No .❑ (Check Appropriate Box)urpose of Baldingcln %%A,-\ l f),‘g %\o,t) Utility Authorization No. Existing Service \no Amps \?9 /'ZcEC Volts Overhead 0 Undgrd j No.of Meters 1 New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work: Completion of thefollowinvable may be waived by the Inspector of Wires. No.of Recessed Luminaires Na of Cert-Sasp.(Paddle)Fans No.of Total Transformers KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming pool Above ln- No.ofirmergency Lighting Brod grad. 0 Battery Units No.of Receptacle Outlets No.of Oa Burners FIRE ALARMS JNo 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 I Tons J KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Munlctpal LL°®1❑ Connection 0 °ther No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent • Heaters KW No.of No.of 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 desired or as required by the Inspector of Wires. Estimated Value of Electrical Worki (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 provides proof of liability innu ce including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covers ellin 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 of perjury,that the in ortnadon on this application is true and ample: FIRM NAME: LIC.NO.: 1 cS 1 Licensee: Signatur I' 0 M ,,-LIC.NO.: ZgCt1 1 (If applicable.enter"exempt"in the license number line.) Bus.Tel.No.: Address: Alt Tel.No.: 5� j 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. 4r5 Q 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 t Owner/Agent j Signature Telephone No. ( PERMIT FEE:$