HomeMy WebLinkAboutBLDE-23-004219 a Commonwealth of Official Use Only
E Massachusetts Permit No. BLDE-23-004219
.4.--' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/07]
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:1/30/2023
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. I �' ��
Location(Street&Number) 248 CAMP ST UNIT H2 J 7 !-TL
Owner or Tenant ANITA SALMU Telephone No.
Owner's Address 248 CAMP ST UNIT H2,WEST YARMOUTH, MA 02673
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replace four thermostats(UNIT H-2)
Co etion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil.-Susp.(P.dd • No.of Total
,Transformers KVA
No.of Luminaire Outlets No.of Hot Tubskit% Generators KVA
No.of Luminaires Swimming Pool ' " \ 43 In- No.of Emergency Lighting
grn•. ttery Units
No.of Receptacle Outlets No.of Oil Burners /70 <y�IRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
nitiatine Devices
No.of Ranges No.of Air Cond. TotaTons ' No.of Alerting Devices
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 0 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 Ballasts Data Wiring:
Heaters Signs 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: THIELSCH ENGINEERING INC
Licensee: RALPH A CARROCCIO Signature LIC.NO.: 16657
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: 1341 ELMWOOD AVE, CRANSTON RI 02910 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 my
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: $50.00
NI,A q 2423 v 6 .,64144 ckuo
,y
Commonwealth
icial Use Only
o � 1asaciLsetLs
1 —_ _ _
_.�,�_ f cc-�� Permit No. 23 - 4 ( 7
_°__i,1= Thepartmeat of Sire Service)
:r-== = = Occupancy and Fee Checked
\"7 -ri= BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07. r,�Y . ° (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: 1/23/2023
City or Town of: West 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) 248 Camp Street Apt. H2
Owner or Tenant Anita Salmu Telephone No. 617-435-8326
Owner's Address
Is this permit in conjunction with a building permit? Yes No PC1 (Check Appropriate Box)
Purpose of Building Residential Utility Authorization No.
Existing Service Amps / Volts Overhead n Undgrd III No. of Meters
New Service Amps / Volts Overhead [I] Undgrd E No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Replacing 4 existing thermostats
RISE_EPermits_RSR81@RISEEngineering.com
Completion of the following table may be waived by the Inspector of Wires.
ofTotal
No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No.
TransformersKVA KVA
No. of Luminaire Outlets No. of Hot Tubs Generators KVA
No. of Luminaires SwimmingPool 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
Total No. of Ranges No. of Air Cond. 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 D Municipal LIOther
Connection
No. of Dryers Heating Appliances KW Security Systems:*
r3' 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 Telecommunication q g No. of Devices or Equivalent
OTHER:
I
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $95.64 (When required by municipal policy.)
Work to Start: 1/30/2023 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 LI OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
FIRM NAME: Thielsch Engineering LIC. NO.: 16657A
Ral h Carroccio Ralph Carroccio :r �u LIC. NO.:
Licensee: p Signature P ..�` u_' �.m�g:"`5
(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 bylaw. By my signature below, I hereby waive this requirement. I am the (check one) LI owner LI owner's agent.
q
Owner/Agent PERMIT FEE: $ 50.00
Signature Telephone No.
ti