Loading...
HomeMy WebLinkAboutBLDE-20-000710 or Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-000710 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:8/7/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm ttl.c4trical work descrilow. Location(Street&Number) 83 LONG POND DR (7J-(('13:> Sg Owner or Tenant ELNINC.CiAlokleflePff Telephone No. Owner's Address 1-SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade 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 0 In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 1 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 ❑ 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 VA,%._• 0 _ ( mmonmsatth.of//lassachu .tt Official Use Only '- Serviced 'O7 WCAew ri_ 2epariment / S Permit No. l 4 T o arvicct Ia - , . BOARD OF FIRE PREVENTION REGULATIONS ZRevU cy and Fee Checked (leave blank) W �i ° APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL ►/�� V N. Z All work to be performed in accordance with the Massachusetts Electrical Code C),5 7 CMIZ 12.00 WORK ORK W `" J 'LEASE PRINT IN INK OR TYPE ALL INFOR.MITIONJ Date: $ 1 `,Ct a City or Town of: YARMOUTH m m To the Inspector of Tres: y this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) $ ) L„o N s (�pN Owner or Tenant %TO el e. a Ni,OS S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No . ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service \.d© Amps ,749 /2443 Volts Overhead Und d tt' ❑ No.of Meters New Service 1(0 0 Amps 1f'20 fl 4.0 Volts Overhead❑ Undgrd gr ❑ No.of Meters ____\._ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cj cj %c.E. C c\ (A„n Q e `o(.5 A Completion oj the followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No.of CeR.-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!":mergency Lrghttng - Prnd. ;=rnd- ❑ 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 J Initiating Devices Total No.of Ranges No. of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:l + Detection/AlertingDevices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Omer No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - OTHER: No.of Devices or Equivalent - 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: 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 cove a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER I certify, under th ai ❑ (Specify:) p �sand penalties of perjury,that information on this application is true and camplet FIRM NAME: \`p Q., t' C. O ('=k SL Licensee: V,LU C L. �+ LIC.NO.: , I ` Ci0 Signature LTC.NO.:�: 2, (Ifapplicabl .enter ez�ptn the�[icense number lined „� Address: % �' „ [Z 6 rL Bus.Tel.No.: 3 .j "Per M.G.L. c. 147,s.57-61,security wo requires Department of Public Safety Alt.Tel.No.: - 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 r Owner/Agent0 owner's a eat. Signature � Telephone No. PERMIT FEE: S _