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HomeMy WebLinkAboutBLDE-20-005784 or Commonwealth of Official Use Only '.; Massachusetts Permit No. BLDE-20-005784 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] APPLICATION FOR PERMIT TO PERFORM ELECTRICA WORK All work to be performed in accordance with the Massachusetts Electrics Code ( C),527 CMR 12. 01 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:5/1 20 X 41'; Ar::; \� City or Town of: YARMOUTH To th nspector fres: �.,. By this application the undersigned gives notice of his or her intention to perform the electrical work described below. �i;'''''` Location(Street&Number) 6 MALLARD ST 410 © y$�` Owner or Tenant BERARDI MICHAEL J Telephone No f3,, @t 420 /, Owner's Address BERARDI ELAINE R, 51 BIRCH ST, STOUGHTON, MA 02072 '``� i)-/, Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriat /iLQ�) i / Purpose of Building Utility Authorization No. �,,,_ Existing Service Amps Volts Overhead 0 Undgrd 0 No. 21)14::s / New Service Amps Volts Overhead 0 Undgrd 0 No C Number of Feeders and Ampacity Q Location and Nature of Proposed Electrical Work: Wire remodeled kitchen,air handler in attic,NC co r•�= •: a- • Completion of the following table may a-4 atv t s. r fres. No.of Recessed Luminaires 10 No.of Ceil:Susp.(Paddle)Fans No.ofet, Transformers No.of Luminaire Outlets 2 No.of Hot Tubs Generators /I( No.of Luminaires Swimming Pool Above ❑ In- 1:1No.of Emergency Lighting grnd. grnd. Batter,Units No.of Receptacle Outlets 6 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 8 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 Total 2 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 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: THEODORE H FITZGERALD Licensee: Theodore H Fitzgerald Signature LIC.NO.: 38794 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:43 THORNBERRY CIR, MASHPEE MA 026493342 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: $75.00