HomeMy WebLinkAboutBLDE-23-15932 5/24/23,2:48 PM •wdo about:blank
• 1 l/(�/ Commonwealth of Massachusetts
v tk.) Town of Yarmouth
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ELECTRICAL PERMITA
Job Address: 95 WASHINGTON AVE Unit:
Owner Name: Dilman Ribiero
Owner's Address: 120 Cobblestone Rd Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15932
Existing Service Amps/Volts Overhead D Underground❑ No.of Meters:
New Service Amps/Volts Overhead 0 Underground❑ No. of Meters:
Description of Proposed Electrical Installation: install two lights(774-534-6064)
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❑ No.of Devices:
Swimming Pool: ln-Grnd.❑ Above-Grnd.0 Hot Tub❑ 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 ❑ 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❑ Ground-Mount 0 Level 1 D Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 0 Work to Start: May 8, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: License Number:
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Fee Paid: $75.00
Email: Business Telephone:
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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Co rionwealth of Massachusetts Official use Only S
y11-r - , '' 2023 I Permit No.: 1�( -Z-3 / %�j
1;_ ,- 'i '` artment of Fire Services Occupancy and Fee Checked:
1P— IRE PREVENTION REGULATIONS [Rev. 1/2023]
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1 '' ',. - ATION 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: Lk.-) 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): ?S w IctS\rx.i r.G-k_,ry fq 0 Unit No.:
Owner or Tenant: :,7 i\t ti.fa,:v A , ,.‘k\..) ,i ACN Email::I) ►-✓.,g\c\.e A(Lctl h(c,1 t-Ar4t( Ce'"x<
Owner's Address: 9 5 ��9,5 V-1/4 t r. E*(CI r-' CA 0, ._). Yet rt :D,_4411 Phone No.:-7)tf-.S 3 it..6O6-(
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: 71 c �,d`1 c-F\__-,0 (.,V Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: t«5k.A(_1 2 i;cf L Z 5.
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: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Grnd.❑ 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❑ 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 0 Level 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email: Telephone No.:
I certify,under t • ,, '.. '•s of perjury,that the information on this application is true and complete.
_� Print Name:-Pt \I"-..41+'k f4,l SC1 (IC Cell.No.:7/'1'53 1-6O6"(
I ' ' • ":"I` -e ERAGE: 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❑
Owner/Agent: Tel.No.:
Signature: Email.: