BLDE-18-003211 co Commonwealth of Official
•
Massachusetts Permit No. BLDE-18-003211
•
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked •
[Rev.1/07j
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:11/30/2017
City or Town of: YARMOUTH To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below.
Location(Street&Number) 15 GENEVA RD
Owner or Tenant ALIBRIO JAMES J Telephone No.
Owner's Address 100 RANDOR STREET, HARRISBURG, PA 17110r,
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Ap i 41 .0
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Me a
New Service Amps Volts Overhead 0 Undgrd 0 No.of(1/4
ten
Ar a.s
Number of Feeders and Ampacity . 1Proposed Electrical Work: Wring of addition. </(vvA/,/ ,
Completion of the following table may be waived by the InspecT"CoflVires.
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 I - ❑ 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 0 Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Eauivalent
No.of Water KW No.of No.of Data Wiring:
Heaters Siens Ballasts No.of Devices or Eauivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Eauivalent -
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: Russell L Haden
Licensee: Russell L Haden Signature LIC.NO.: 36613
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:36 CAPTAIN STUDLEY RD.MARSTONS MLS MA 026481265 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,)hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$75.00
W1)&111 4/(7 f
•
• ''// yy/
= Comrnorave lh of///a1Lec sft, • 0{neiaiUse ly
yet c�7/ ['� Permit No.
c`� '�1
1JcParlmcrrt of giro Serviced
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] • (leave blank
)
APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK
All work to be pm-formed in accordance with the Massachusetts Electrical Code
(MEC),527 CMR 12.00
(PLEASE PRINT IN IM;OR TYPE ALL INFORMATION Date: /%._
City or Town of: YARMOUTH To the Inspecto•
r of Wires:
. By this application the undersigned,gives notice of his or her intention to perform the electrical work described below.
. Location (Street&Number) f lj ( V:1..
Owner'orTenant Ti el y4 0 t) Telephone No.
Owner's AddressA--,titC
Is this permit in conjunction with a bwlding permit? Yes No ❑ (Check Appropriate Boz)
Purpose of Bmltfrtrg cp 1-A 6" Utility Authorization No.
Existing Service Amps / Volts Overhead E Undgrd
❑ No.of Meters _
d r i- ew Service Amps / Volts Overhead❑ Undgrd ❑ Na.of Meters
•�I •—•-� /i umber of Feeders and Ampacity
t
c•-- Location and Nature of Proposed Electrical Work: WI Fe S �� 1'(" 77
Completion of the following table may be waived by the Inspector of fres.
I Na.of Recessed Lumiaases Na.of Cet7-Susp.(Paddle)Faas No.of Total
ITranformr ICVA
No. of Lamirraire Ounlet No.of Hot'Ibbs Generaton [CVA '
a No.of Luminaires Swimm4ng Pool '°'hove Ia- No,of nmergeacy Lrghtmg •
—
"rnd.. 0 '_incl, (Battery Units
No. of Receptacle Outlet No.of Ott Burner I
FIRE ALARMS [No.of Zones
No.of Switches Na.of Gas Buser . No.of Detection and
sr
• Iaitiatinu Devices
No.of Ranges No. of Air Cond. Tons No.of Alerting Devices
•
Heat Pump Number I Tons I KW No. of Self-Contained
Totals: Detection/Afettina Devi
No,of Waste Disposers
ces
No. of Dishwashers S ace/Area Heating KW' Municipal
p Local Q Connection 0 Other
No.of Dryers [Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
No. of
Heaters KW No.of Data Wiring
Sires Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
—
Attach additional detail if desired or as required by the Inspector of Wires.
Estimated Value of Electrical World (When required by municipal policy.)
Work to Start; Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSLJRAI'iCE 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 ❑ OTHER 0 (Specify:)
I art", under the pains and penalties ofperjury,that the information on this application is trite and complete '
FIRM NAM'•
Licensee: 6,„ ■C, /a\ LIC_NO.:
Signature f ele, Af LIC.NO.:
(Ifapplicabl:'enter"exempt"int e license number line)
Address: .G.' , al3 : A ,1 kJ-, MMS Bus.TeL No
J "Per M.G.L. e. 147,s.57-61,sec ' work requires Department of Public SafetyAlt Tet.No.: O
4u eP "S"License: Lie.No. —
�zOWNER'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)0 owner 0 owner's agent
- Owner/Agent
vl Signature Telephone No. I PERMIT FEE: $
L