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Commonwealth o`Maosaclzuoette icia Use Only i (
'L G't ..Department 0/ -ire�ervices Permit No. L—�I,
i c-= 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 performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: July 24, 2020
City or Town of: South Yarmouth To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
/
Location(Street&Number)6 Locust Street /
1
Owner or Tenant Wrzesinski, Tamara Telephone No. 5 8-596-2524 /
Owner's Address 48 Daniel Street, Slingerlands, NY 12159 �,
Is this permit in conjunction with a building permit? Yes El No ® (Chec.p , , • '
Purpose of Building Residential Utility Authorizatiph, 4 •ff r
Existing Service 100 Amps 120/240 Volts Overhead V Undgrd L* if. t , • i
New Service Amps / Volts Overhead❑ Undgrd ❑ i.
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install new washer outlet. Upgrade 2 existing receptacles • •'+,•.
Repair existing electrical deficiencies at basement. Install additional basement lighting and inspect existing wiring.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil: p•(Paddle Sus F Tf Total) ans Trr anosformers KVVAA
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
of
No.of Switches No.of Gas Burners No. Initiatinnggon Dete and
In Devices
No.of Ranges No.of Air Cond. Total
g Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW Local Municipal
❑ Other
p Connection
No.of Dryers Heating Appliances KW Security No. f Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.H
Y g No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $3000 (When required by municipal policy.)
Work to Start:7/27/2020 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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INSURANCE Exp:07/31/20
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: REILLY ELECTRICAL CONTRACTORS, INC. LIC.NO.: 9897A
Licensee: MICHAEL J. MCSHEFFREY Signature !� 1"--(/„.7,5 LIC.NO.:9897A
(If applicable,enter "exempt"in the license number line.) <. . Bus.Tel.No. 508-771-2040
Address: 110 OLD TOWNHOUSE ROAD,SOUTH YARMOUTH,MA 02664 Alt.Tel.No.: 508 400-8936
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE: $ °—J .�
Signature Telephone No. �j
N/a ?/3/2,0 s.
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