HomeMy WebLinkAboutBLDE-23-18935 6/14/23,3:36 PM about:blank
�'=:� Commonwealth of Massachusetts 01 :
* Town of Yarmouth •
ELECTRICAL PERMIT c , r- '
Job Address: 205 WHITE ROCK RD Unit:
Owner Name: COOPER RYAN M COOPER ELAINE R
Owner's Address: 205 WHITE ROCK RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-18935
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: Kitchen remodel
No.of Receptacle Outlets: 7 No.of Switches: 3 Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: 7 No.Wind Generators: Wind KW Rating:
No.Appliances: 6 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 El No.of Devices:
Swimming Pool: In-Gmd.0 Above-Gmd.0 Hot Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 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 0 Rating:
Estimated Value of Electrical Work: $4,000 Work to Start: June 9, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: DAVID G LEACH License Number: 15886
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: CENTERVILLE, MA, 026320770 CENTERVILLE MA 026320770 Fee Paid: $50.00
Email: davidleachelectrician@gmail.com Business Telephone: 774-226-478
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.: r�3-- k lei 3"
_a, .` DQp rtment o Fire Services
f Occupancy and Fee Checked:
. f y l�bkib` ' I 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: j- h'PU 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): Z O 1RC' Ajs,(,,K. yq-:Jnit No.:
Owner or Tenant: ,- C p o r e� G'.1tAsl. to1v
Email: cylct,t,'c et ,�o,K .{. z��
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Owner's Address: .,�jz z Phone
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No Petermit No.:
Purpose of Building: /LDS) V z i-)Tan Utility Authorization No.:
Existing Service: / ve, Amps /,Zh'z,Volts Overhead Underground 0 � ilr-- No.of Meters:
. • New Service:
Amps / Volts Overhead❑ Underground 0 No.of Meters:
Description of Proposed Electrical Installation: c L.2 Le/O(e- c k<t'T'G 13 c—n-c a 17erd--->
Completion of the following tab a may be waived by the Inspector of Wires.
No.of Receptable Outlets: 7 No.of Switches:
� Generator KW Rating: Type:.
No.Luminaires: No.of Recessed Luminaires: 7 No.Wind ing:
No.Appliances: KW: 4, No.Water Heaters: KW: No.Transformers:tors: Wind TotalKVA:KW t
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:In-Grnd.0 Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System
No.Air Conditioners: ❑ No.of Devices:
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-Mountpp e
OTHER: 0 Level 1 0 Level2 0 Level 0 Rating:
Attach additional detail if desired,ohs required by the Inspector of Wires.
Estimated Value of Electrical Work: r 9
Date Work to Start: - Y --A Inspections
required by municipal policy)
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee:
LIC.No.:
Journeyman Licensee: /A-/t,Y7 J
LIC.No.: j.J`'rere z �
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: Pc, l3es"� z 70T GE'�u re:-�ut/1¢
/ /!'J� d eb 3.. ,
Email: c..4 a-Vi GA/ f E,i ���=.7-i2lLyif 0_GMt4ti\..
e- /1. Telephone No.: ;Agi."÷--titeklis-
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I certify,under the pains and penalties of perjury,that the information on this application is trt an t i pi .-z 7$
Licensee: c rint Name: L G_
INSURANCE COVERAGE: Unless waived by a owner,no permit for the performance of electrical work may issueunless the 4
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 s to the permit issuing office.
CHECK ONE: INSURANCE(BOND El OTHER 5 ,g`z3
❑ Specify:�stl)!� 7r4�g� �j£'S4 t clt-
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:
Tel.No.:
Signature:
Email.: