BLDE-21-000651 Commonwealth 0/Vaddacnujetfe Official Use Only
1 t c� Permit No. tZ' -'V (pc-j
c si- 2epartment o f_tire Serviced
'_!!— , 4 Occupancy and Fee Checked
'` _ i 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: 7/21/20
City or Town of: 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) 15 Thacker Street
Owner or Tenant Joan Brazeau Telephone No. 508-362-1244
Owner's Address claflash@riseengineering.com 1
Is this permit in conjunction with a building permit? Yes n No ® ( eJ : i4„,1 1r
Purpose of Building Residential Utility Autho .. e t 1 N. O
l�
Existing Service Amps / Volts Overhead❑ Un 8 1 8,M (72) ' '4 1 4, a?.e 1
New Service Amps / Volts Overhead❑ Undgrd II I -<, r O- ' It
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace 4 existing thermostats 4 p
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tof
Traa onKVAsformers 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 AlertingDevices
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 WaterKms, 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: 540.00 (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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑■ BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information ,n ' 1•'lb b• ion is true and complete.
FIRM NAME: Thielsch Engineering / LIC.NO.: 16657A
Licensee: Ralph Carroccio Signature g / , i LIC.NO.:
(If applicable,enter "exempt"in the license number line.) "I Bus.Tel.No.: 401-784-3700
Address: 1341 Elmwood Avenue,Cranston,RI 02910 Alt.Tel.No.:
*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)El owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00