HomeMy WebLinkAboutBLDE-21-000652 #9 Commonwealth o`7ajjac/ueetta Official� � Use Only
t = M� 't cc�� c7 Permit No. 'UPS-
C_1mt 1 2)epartment o f,.tire Services
11 Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
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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)9 Connemara Way
Owner or Tenant Data Yardumian Telephone No. 508-685-6872
Owner's Address claflash@riseengineering.com
Is this permit in conjunction with a building permit? Yes n No ® (Check Appropriate Box)
Purpose of Building Residential Utility Authorization 0
Existing Service Amps / Volts Overhead❑ Undgr ► eters i
New Service Amps / Volts Overhead n Und �,� ,1�� r' Z
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace 3 existing thermostats /
Completion of the following table may be waived by t I o . fires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above r—i In- ❑ No.of Emergency Lighting
grnd. grnd. Batten,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 DIOther
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of WHeaters KW ater No.of No.of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
Telecommunications Wiring:No.Ilydromassage Bathtubs No.of Motors Total HP 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: 405.00 (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 informatio n lication is true and complete
FIRM NAME: Thielsch Engineering
LIC.NO.: 16657A
Licensee: Ralph Carroccio Signature LLC NCO.•, ,,
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.: 4 �b4-3700
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