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Home My WebLink Aboutblde-19-005855 0 - Commonwealth of Official Use Only -gE. Massachusetts Permit No. BLDE-19-005855 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 IN INK OR TYPE ALL INFORMATION) Date:4/18/2019 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 electncai work described below. Location(Street&Number) 130 SOUTH SHORE DR Owner or Tenant KOEHLER STEPHEN W Telephone No. /� Owner's Address 703 ASH ST, BROCKTON, MA 02401-5755 �j Is this permit in conjunction with a building permit? Yes 0 No 0 (ClIc k. ropri*t Box)/„ 1 Purpose of Building Utility Authorization No - II�YJh Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New residence. 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- ❑ 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 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: $180.00 oa,ti 4(1 9 k rg-- 254- .Ale43- OMA-. 6( /r v — `/'� _ p._• �Ommonrutatlh o`//la�acifs Official Use Only —_ i=- c'� c�� - !!�_ .LJaParfinanf ol.fira Sarviul Pelmet No. ` --CC�/-- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked '..--- _ [Rev. 1/07] ---- (leave blank) APPLICATION FOR=PERMfT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC 527 12.00 C . (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: c ('1 q City or Town of: YARMOUTH To the Inspector of fires: By this application the pndersigned\ilsnotice of his or her intention to orm the electrical work described below. Location(Street&Number) � cC(4kt Ntrk D\ . �1Z - I , 'Owner or Tenant e Y\e A) O� f Z C.:.�.. Telephone No. +. Owner's Address Is this permit in conjunction with a building permit? Yes _T'- No ❑ (Check Appropriate Box) Purpose of Building )(2_(-.) �O.) c C Utility Authorization No. 'L_3 5 `.. E Existing Service Amps / Volts Overhead ❑ Undgrd — .' 4 ❑ No.of Meters New Serviced Amps /2 tf Woks Overhead 11'---Undgrd E No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 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 V No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimmia pool Above In- No.of l!:mergency Lighting • g ernd. Li grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1No.of Zones (-- No.of Switches No.of Gas Burners No.of Detection and cil No.of Ranoes Total Initiating Devices g No.of Air Cond. Tons No.of Alerting Devices 1 No.of Waste Disposers Heat Pump I Number'Tons I KW No.of Self-Contained Totals: 1 Detection/Alertino Devices Q No.of Dishwashers Space/Area Heating KW' I, Municipal i. ❑Connection ❑ �� (f No.of Dryers Heating Appliances Kyi, Security Systems:k No.of Water No.of No.of Devices or Equivalent (� / Heaters KWNo.of Data Wiring: �i/ Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: J 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.) V Work to Start: Inspections to be requested in accordance with MEC Rule l 0,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 vundersigned certifies that such covers is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER. ❑ (Specify:) I cerizfy, under th ppittsand penalties ofp f rju ,that the information on this application is true and complete. I (� ' FIRM \ape 'Cl...l (.c 1C` ►L t LIC.NO.: l /§ I; I Licensee: um.._ Signatur -c__LIC.NO.:Z '? (If applicable enter " m t"in a livens ber fin -) 41". Address. C 0 `J ,l '� N Bus.TeL No.: ^� �// �� Alt.Tel.No.: J "`Per M.G.L. c. 147,` 57-61,security work require arenent bf Public Safety"S"License: Lic.No. y�86 — 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)0 owner ❑owner's agent.Owner/Agent Signature Telephone No. f PERMIT FEE: $ �j(�,