HomeMy WebLinkAboutBLDE-23-19352 8/17/23,7:45 AM about:blank
Commonwealth of Massachusetts o 1" 4 `
* Town of Yarmouth •
t (•. , {add ".
ttf
1 ELECTRICAL PERMIT ` .,
Job Address: 757 WILLOW ST Unit:
Owner Name: SUTHERLAND BARBARA H TRS BARBARA H SUTHERLAND REVOC TRUST
Owner's Address: 757 WILLOW ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19352
Existing Service Amps/Volts Overhead ❑ Underground ❑ 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: In-Grnd.0 Above-Grnd.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❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: August 17, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: MICHAEL D HOLLISTER License Number: 10071
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: S YARMOUTH, MA, 026641017 S YARMOUTH MA 026641017 Fee Paid: $50.00
Email: mikehollisterelectricahotmail.com Business Telephone: 508-776-5319
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:
(& W7&3ez
1/1
about:blank
RECEIVED
,,,- , m. 6 2023
C mmonwealth of Massachusetts Official Use O} y
�! = t Permit No.: t`�� N.- . 3 5 Z
Bui � NI—
F. �_ ARTMENT Department of Fire Services Occupancy and Fee Checked:
By k;-- !;— -' '' ' s_ F FIRE 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 C R 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): 757 ItAn C,t-air/' ST Unit No.:
Owner or Tenant: ggit-iv- re-e.....a.4 o. Email: EAI�/7 AA)O2 1,- , co
Owner's Address: Phone No.: S'Cie ( 1 5 q g
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No aPermit No.: 1
Purpose of Building: f cSi 06ter &` Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground❑ No. of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: S� 7( G- re/1,14.c? 4 / -z_ ,v2 Is._
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❑ 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 El Ground-Mount❑ Level 1 0 Level 2 0 Level 3 0 Rating: 0
OTHER: L.
Attach additional detail if desired,or as required by the Inspector of Wires. --�`
Estimated Value of Electrical Work: 7�6 '� (When required by municipal policy) -,V
Date Work to Start: ,0'/t '/,L Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1,11
FIRM NAME: yAA,. k ea4-0. C-- Q kin 2-L t 5 p[.�'_ A-1 ❑or C-1 0 LIC.No.: V
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: ittit 1 f - L 5 i`�1\-- LIC.No.: / )O 7 1 -
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: g 5- j,c/Jl i S ��c 4r/ �� 0 A-
Email: Telephone No.: 5-628 1'7 to 3�) 15
I certify,under the pains and penalties of perjury,that the infor ati on this a ication is true and complete.
I
Licensee: Al l[ Print Name: `Cell.No.: l( Z5'
INSURANCE COVERAGE: Unless waived by the owner,no 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: INSURANCEg BOND 0 OTHER 0 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.: