HomeMy WebLinkAboutBLDE-23-19002 6/27/23,6:33 AM about:blank
Commonwealth of Massachusetts � ,� Yy�
,4401
Town of Yarmouth �
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ELECTRICAL PERMIT
Job Address: 2 MILL LN Unit:
Owner Name: MAKER ANDREW P MAKER ERIN R
Owner's Address: 2 MILL LN Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19002
Existing Service Amps/Volts Overhead 0 Underground 0 No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Install receptacle over fire place.
No.of Receptacle Outlets: 1 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 El 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 ❑ 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 ❑ Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: June 26, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JACK W GRIFFIN License Number: 418
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: S YARMOUTH, MA, 026641339 S YARMOUTH MA 026641339 Fee Paid: $75.00
Email:jackgriffinelectric@comcast.net Business Telephone: 978-479-2521
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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RECEIVED 750�
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--—JUN 2 6 tivrooiiwealth of Massachusetts Official Use 0 ly
Permit No.: Z1 —eJ CO'Z
t� lr�= � Depalrtment of Fire Services Occupancy and Fee Checked:
Ia= 8(�ARb2�1 'F�IIE 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: �/ 6 a-T
To the Inspector of Wires:By this application a undersigned gives notices of his or h r intentign to perform the electrical wo1k described below.
Location(Street&Number): I L, N-e., einet Unit No.:
Owner or Tenant: Email:
Owner's Address: Ay>v2._J Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No❑Permit No.:
Purpose of Building: 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: f,ID PIVG Aho'i--a' 1 j4
r
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.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❑ 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 Elec ical ork: (When required by municipal policy)
Date Work to Start: ( ai c L3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: J j Cr, jw A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.: 714x / /5
Journeyman Licensee: LIC.No.: E L 9/9
Security System Business requires a Division of Occupational Lic nsure" "LIC. S-LIC.No.:
Address: r�6 i.
O AiJAlii 7 gZ 0 U j �1}2 '0;. R4A
Email: J���. 7 ur: J'Ii\) /c C�"rc/c CCoil GIST' >keelTelephone No...
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I certify,under th n a enalties of perjury,that the in ormation on this a lication is true and complete.
Licensee: Print Name: ,�� (j ri HCI") Cell.No.:
INSURANCE E E: Unless :ived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof tabil' eluding"co •leted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force an as ex ited proof of s.. e to the permit issuing office.
CHECK ONE: SURANCE 1E 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.: