HomeMy WebLinkAboutBLDE-23-19740 10/25/23,2:49 PM about:blank
�x Commonwealth of Massachusetts Gov •,Y4
Town of Yarmouth
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ELECTRICAL PERMIT 1 � sl 5r.
Job Address: 19 CHANDLER GRAY RD Unit:
Owner Name: VINCENT COLLEEN DIAUTO JOHN
Owner's Address: 19 CHANDLER GRAY RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19740
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 wiring.
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.El Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: 0 Video System ❑ No.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:
Estimated Value of Electrical Work: $550 Work to Start: October 23, 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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Ph__ t Permit No.: �'L� CI
BU , V! Department of Fire Services Occupancy and Fee Checked:
BY'_ ti=�4 1§bAikb F 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 1 j.00
City or Town of: YARMOUTH • Date: /0/ .,5-/ J 3
To the Inspector of Wires:By this applicati n,the un er igned gives notices of his or he in ention to perform the electrical work described below.
i Location(Street&N her): /9 C C(ha r-/e C'v 4 v/ /rd , Unit No.:
Owner or Tenant: U ei ti fri. f i' Li-1-0 Email:
Owner's Address: S'M 4/e Phone�No.• 78/ /9 3 .&
Is this permit in conjunctio with a building permit?(Check appropriate box)Yes❑ No Q'Yermit No.:
Purpose of Building: A Utility Authorization No.:
Existing Service: / � Amps / Volts Overhead❑ Underground 0----- No. of Meters:New Service: Amps / Volts Overhead❑ Underground No. of Meters:
Description of Proposed Electrical Installation: /� c 6 'l ,�
� I �� II�'I Vic. �il b 'l C� .�Z�z.� ��i �_
Completion of the following table may be waived by the Ir pector of Wires.
.•• No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type:.
I V 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-G
9..)
rnd.❑ 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:
d 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 ❑ Level 2 0 Level 3 0 Rating:
L OTHER:
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Attach additional detail if desired,or as re Bred by the Inspector of Wires.
c)I Estimated Value of Electrical W rk: c5c),,,,,, (When required by municipal policy)
V Date Work to Start: Ins ections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: /17G c% , /,,,, v
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� / � A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: f 0104 y ,'14•c�'c e LIC.No.: / 'C 5- A
�1 Journeyman Licensee: LIC.No.:
c
Security Syste usiness requires a Division of Occupati nal Licensure"S" S-Lc.No.:
Address: 0 &--,K 9 ii ' '
...V..s. Email: Telephone No.: / : � ,S
I certify,unde the pains an penalties of erjury,that the information on this application is true and complete.
Licensee: r Print Name: ' l 4 oils r ) LL 1-Cell.No.: 775` 5 1/.. 3 INSURAN E COVE - : nless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"comp) ted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER❑ Specify:
P fy:
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.:
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