HomeMy WebLinkAboutBLDE-23-19527 9/20/23,=:55 AM about:blank
A. Commonwealth of Massachusetts -01 4 's
*� Town of Yarmouth •
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ELECTRICAL PERMIT �1 .
Job Address: 9 CAPT LOTHROP RD Unit:
Owner Name: BELAND DAVID J
Owner's Address: P 0 BOX 1262 Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19527
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Replacement boiler&add smoke/CO detector
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: In-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: 0 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❑ Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: September 19, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: THOMAS J MADDEN License Number: 14065
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: YARMOUTHPORT, MA, 02675 YARMOUTHPORT MA 02675 Fee Paid: $50.00
Email: tmaddenelectric@gmail.com Business Telephone: 774-994-2057
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
._ = EP 1 ,� 7 O wealth of Massachusetts Official Use Only
Permit No.: U23 ._ CI s z7
>�;_ De a tment of Fire Services Occupancy and Fee Checked:
IIf_ y5 'illO Rf�` ITT-E PREVENTION [Rev. ]
� REGULATIONS 1/2023
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), CM 12.00
52
City or Town of: YARMOUTH • Date: / /9 , 73
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): 9 Cytcf%ry/ Lc, mkor Unit No.:
Owner or Tenant: ,Dgve A€.-e/c, Email:
Owner's Address: S.q/yl Phone No.: 5 c. .S`3 6 Sl V6/j"
Is this permit in conjunction wt a building permit?(Check appropriate box)Yes El No I hermit No.:
Purpose of Building: kc S . Utility Authorization No.:
Existing Service: /'EGG' Amps/0V /<P2!Z7 Volts Overhead Ej derground El No.of Meters:
New Service: Amps / Volts OverheadUnderground El No.of eters:
i
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Description o Proposed Electrical Installation: 1d' /etc 0 /L/c ��, , G 4SS 6 I -e
671) /. (7( -14- clAi K(2
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: _ Generator KW Rating: Type:
(3' 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.El Hot-Tub❑ — No.of Self-Contained Detection/Alerting Devices:
` —
.. ) No.Oil Burners: No.Gas Burners: Video System ElNo.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ 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:
U
_` Attach additional detail if desired, or as requir by the Inspector of Wires.
�` Estimated Value of Electrical Work: 6j z-
?, ,,, (When required by municipal policy)
�l/ Date Work to Start: /�},9 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: IC G- 4 vz— A-1 ❑or C-1 ❑LIC.No.:
17) Master/Systems Licensee: !Eai 7 ,--/ fit/( LIC.No.: / Z-70 69 6- izi-
1- 4
Z Journeyman Licensee:
� LIC.No.:
Security Syste Business requires a Division of Occupationalpa Licensure"S" IC. �SLIC.No.:
Address: /36 ( 9 i // , /L/G ✓ '-L ;-- i 7r
Email: Telephone No.: 7 )V 9 9 V- 0.5 7
I certify,under a pai s d pe a ties of perjury,that the in ormation on this application is true and complete.
Licensee: 0/ 7 r C*� II,,,,�� /
'`� Print Name: l�jU!'vl�s �,/'t'fat�ec7 c1 4: Cell.No.: 2 71.-.5%4/./., 2 4,57
INSURANCE 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 s e to the permit issuing office.
CHECK ONE: INSURANCE BOND El 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 El Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: