HomeMy WebLinkAboutBLDE-21-000772 Commonwealth o`//ladoachude l AIb i i ,? 17,0';, Official Use Only
* vi =rt c7 Permit No.
c-z -C77 Z
C - �l 2epartmen�l of ire ervicelt , . -
;— Occupancy and Fee t a� ��
'''', BOARD OF FIRE PREVENTION REGULATIONS 'ev.1/0l] ` 11
(leave
APPLICATION FOR PERMIT TO PERFORM ELECTRy1 WOR ,Z
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527Cr' ► i,i I 2Q20
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7/21/20 ���i
City or Town of: Yarmouth To the Inspector of WI es: ..
By this application the undersigned gives notice of his or her intention to perform the electrical work '-scribed below.
Location(Street&Number)22 Uncle Jimmys Lane
Owner or Tenant Leighann Fuller Telephone No. 508-292-5892
Owner's Address claflash@riseengineering.com
Is this permit in conjunction with a building permit? Yes n No PC (Checkropriat B x)
Purpose of Building Residential Utility Authorization • A I
Existing 5ei-viee Amps / v'o.is Cveckiead❑ Undgrd•I No. " t�t1b
Az
New Service Amps / Volts Overhead ID Undgrd 1113111' o e /Z "r /
'1
Number of Feeders and Ampacity /
C'qa
` �
Location and Nature of Proposed Electrical Work: Replace 5 existing thermostats Completion of the followingtable may be waived by the Insppee
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 l mergency Lighting
gird. 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 ❑
Connection Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Tote'LIP Telecommunications Wiring:
i i No.of Devices or equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 675.00 (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 s. -e to the permit issuing office.
CHECK ONE: INSURANCE ❑j BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information . s ap/lic ion is true and complete
FIRM NAME: Thielsch Engineering LIC.NO.: 16657A
Licensee: Ralph Carroccio Signature ' i J �..�O,:�
(If applicable,enter "exempt"in the license number line.) 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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $50.00
y
I
,.:fid