HomeMy WebLinkAboutBLDE-23-19287 8/2/23,3:40 PM about:blank
Commonwealth of Massachusetts � v •Y-4
*�_ Town of Yarmouth
ELECTRICAL PERMIT �`� .:A $
Job Address: 15 ROBERTA DR Unit:
Owner Name: KANTZELIS ERIN
Owner's Address: 15 ROBERTA DR Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19287
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: Replacement of distribution panel & breakers.
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-Grnd.0 Above-Grnd.❑ 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: $ 1,500 Work to Start: July 31, 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: $50.00
Email:julianrobinson46@gmail.com Business Telephone: 774-368-0824
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the
licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
INSURANCE:
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AUGAIj O 2 iebTnmonwealth of Massachusetts Official Use Only
- Permit No.: E"Z� ( q zL 6 7
e` p`— Department of Fire Services Occupancy and Fee Checked:
�— BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
Y,"
—`' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH • Date: V i l2o z 3
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 15 Zo c-&— - ck, p i.--:i C. Unit No.:
Owner or Tenant: 6,1( i�,,,,, Le3 j ,L Email: &i i I i k.1 C,.w R c.(ah Cw & '1. GC
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Owner's Address: 5 t$,,4 z Phone No.: '4 S--) `12-tfi 4 1 q
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No Ike Permit No.:
Purpose of Building: I?c,ttie,( CL-,.C,6,5 C Utility Authorization No.:
Existing Service: ?,p 0 Amps \ L / 2.4 o Volts Overhead[] Underground❑ No.of Meters: (
New Service: Amps / Volts Overhead❑ Underground 0 No.of Meters:
., Description of Proposed Electrical Installation: I tA. Wt'd i ?c.,,,z i C 1 L t j t_ Sv S 1-- 176„,,r( c-J..
vc,-\CCU„
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 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System
S ❑ 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 ❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: -CCU
(When required by municipal policy)
Date Work to Start: 7/ l//2.0?J Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: S IVtc. C?vt cue
A-1 ❑ or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.: 7 -
Journeyman Licensee: J tj (I c.h. R c t t 4 S'1 LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: I C cc, 4. v i (,v {-`'t^'t1 R0 I Gil L,S-f L,,S' & ) I 0 S t1i gl- G 2,6 C(k
Email: Li I t wil R 0 6 1 h.1 ci°'1 Li G 0 G C,I / Y C.UL, Telephone No.: 7 7 t{ - I v k2
I certify,un r th ads and alties of perjury,that the information on this a plication is true and complete.
.
Licensee: Print Name: V ( l k-14 IS U U t II .Sc, -�l Cell.No.: ? C`( _ 7 6 5'-0 S'2 y
INSURAN E COVERAGE: 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 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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature:
Email.: