HomeMy WebLinkAboutBLDE-23-19000 6/27/23,9-19 AM about:blank
Commonwealth of Massachusetts of-Y4�
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Town of Yarmouth
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ELECTRICAL PERMIT V: ) cf
Job Address: 58 WILFIN RD Unit:
Owner Name: PENN JODI H TR IRREVOCABLE TRUST FOR THE DESCENDANTS
Owner's Address: 515 MAIN ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19000
Existing Service Amps/Volts Overhead 0 Underground 0 No.of Meters:
New Service Amps/Volts Overhead 0 Underground 0 No.of Meters:
Description of Proposed Electrical Installation: Septic pump&alarm
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool: ln-Gmd.0 Above-Grnd.0 Hot Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1,200 Work to Start: June 26, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JULIAN ROBINSON License Number: 58376
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: MARSTONS MILLS, MA, 02648 MARSTONS MILLS MA 02648 Fee Paid: $50.00
Email:julianrobinson46@gmail.com Business Telephone: 774-368-0824
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.
INSURANCE:
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Permit No.: Official Use Only
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0 •rtment of Fire Services Occupancy and Fee Checked:
I' y>%;BOARD'01 ' )-E PREVENTION REGULATIONS [Rev. 1/2023]
'''-"' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date:
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 5s" („, t j la R.p Unit No.:
Owner or Tenant: '5o cL Peh h Email:
Owner's Address: 5-u (.. (f t L R (Q Phone No.: 7''/ 1 z1 q(,(2.7
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: W'eLt/ Sep h C. P vim, el Iq-(�.,,-(.„ Utility Authorization No.:
Existing Service: 2,G a Amps (2.6/ 2410 Volts Overhead Underground 0 No.of Meters: 1
Amps
New Service: / Volts Overhead 0 Underground 0 No.of Meters:
Description of Proposed Electrical Installation: WI LW•!S r tiph C L c Al t-
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: ( Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No:Motors: ( Total HP: `1_ Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Grnd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail f desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Wor : ( 2_0 O (When required by municipal policy)
Date Work to Start: G l 26 /26231nspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: c I V C-Gx. G r a Lip A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: U I 'cc,10, Z( b 1`4.St%-% LIC.No.: 5 fr3 7 G — 8
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: t 26 s�A,.-Ft/C f n/=24.-v 1-0("At g, P . V14 G v- c 1-r S Pt/'1/c i:"l fit-0 2‘yJ/'
Email: 50 I i S.i,, 1'o d l'�s et., — G G c. I .L G� Telephone No.: ?c .3 ��'— O�2Y
I cent ,un t pains and allies of perjury,that the information on this application is true and complete.
Licensee: Print Name: a" U Its L iZ a t k col, Cell.No.: 2 2 t(3 G '®5-..Z Y
INSURANCE COVERAG :Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability 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:
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 0
Owner/Agent:
Tel.No.:
Signature:
Email.: