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Home My WebLink AboutBLDE-23-19775 1112/23,7:17 AM about:blank Commonwealth of Massachusetts ©F • Yq * Town of Yarmouth z ELECTRICAL PERMIT Job Address: 391 ROUTE 28 Unit: Owner Name: TOWN OF YARMOUTH Owner's Address: 1146 ROUTE 28 Phone: Email: Purpose of Building Commercial Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19775 Existing Service Amps/Volts Overhead❑ Underground ❑ No. of Meters: New Service Amps/Volts Overhead❑ Underground ❑ No. of Meters: Description of Proposed Electrical Installation: Emergency switch for boiler required by insurance company. No.of Receptacle Outlets: No.of Switches: 0 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: ln-Grnd.❑ Above-Grnd.❑ 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 ❑ 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: November 2, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: ROBERT J CARLSON License Number: 16945 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: W YARMOUTH, MA, 026733752 W YARMOUTH MA 026733752 Fee Paid: $0.00 Email: bobcarlsonelectric@gmail.com Business Telephone: 508-294-2416 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: (X_Sj__ 1L.(ct(t 'S about:blank 1/1 Commonwealth of Massachusetts Official Use Permit No.: t-Z3 —1I/j'/ -_-' � e/ Department of Fire Services Occupancy and Fee Checked: r 1 o p Y : = BOARD OF 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 CMR 12.00 City or Town of: („) YARMOUTH Date: 4o-1 2e9 ' 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): 3 9y a 7-2? Unit No.: Owner or Tenant: "7 ,./4/ !� )//57,07 W-4 Email: Owner's Address: Phone No.: Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 NoE Permit No.: Purpose of Building: I r. /24 Q /\`' Utility Authorization No.: Existing Service: . 00 Amps iZe,12X5Volts Overhead❑ Underground❑ No. of Meters: z- New Service: Amps / Volts Overhead 0 Underground 0 No. of Meters: . Description of Pr osed Electrical Installation: /1(-1 4'rot/cm' ( 7 4// -1-17;71-ii "/t/e� 1 raj>; 7A oi , . sty ,/!C' Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: No.of Switches: 6-t' Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: Yp 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.❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System Y 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: SecuritySystem stem y ID No.of Devices.... Solar PV KW DC Rating: _ Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment R F, ( 7 i v D No.of Modules: Roof-Mount 0 Ground-Mount ❑ Level 1 0 Level 2 0 Level 3 0 Rating:. '" OTHER: - NOV 0 1 2023I Attach additional detail f desired,or as required by the Inspector of Wires. { Estimated Value of Electrical Work: >I N U DE PA k I W h T Date Work to Start: /7- / " � (When required by municipal pohcx)_ _ _ _ _ ___ .3 Inspectionsio to be requested in accordance with MEC Rule 10, and upon completion. FIRM NAME: (yf q /titer/ l( /; 7e-e ,- A-1 0 or C-1 0 LIC.No.: Master/Systems Licensee: Qom'ehr��'/e/fai-,/ LIC.No.: iet / , 1Yr Journeyman Licensee: 4.0tlt/� ,131// G5- 9 �r � LIC.No.: JP� �/ Security System Business requires a Division of Occupational Licensure"S"LIIC. S-LIC. No.: Address: j ///7y,crY a G.JZ�., ! /4l�!/�� !✓�Email: /,4tin/1/G(JC%/7 '�0 G-'/1'4.,e•/. C it Telephone No.: J_ ..29YZ,5"/,6 I certify,and the ai and en ties of perjury,that the in ormation on this application is true and complete. Licensee. Print Name:��"/7% i ce Cell.INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance nce o electrical work mayissue ss q/� /� 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. unless the licensee CHECK ONE: INSURANCE BOND 0 OTHER 0 Specify: , OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have he liability insurance coverage n required by law.By my signature below,I hereby waive this requirement.I am the:(Check one)Ownerg normally Owner/Agent: 0 Owner's agent 0 --—____ Tel. No.: Signature: Email.: