HomeMy WebLinkAboutBLDE-23-15918 5/23/23,7:08 AM about:blank
Commonwealth of Massachusetts Y� ,,
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u Town of Yarmouth z. �`°
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ELECTRICAL PERMIT N1v ,if:-
Job Address: 27 LONGVIEW RD Unit:
Owner Name: KOSSACK ROBERT E TR KOSSACK GRETCHEN I TR
Owner's Address: 7 REDCOAT RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15918
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead 0 Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Septic pump &alarm
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: 1
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: 0
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: May 23, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ROBERT F THIBEAULT License Number: 22475
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: BREWSTER, MA, 026312806 BREWSTER MA 026312806
Email: bobthibeault@comcast.net Business Telephone: 508-237-1739
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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' RECEIV ! D
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2023
Commonwealth.
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BOARD OF FIRE PREVENTION REGULATIONS {Rev. 1/07] (leave blank)
c_ All FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: _'7Z-z-/Z3
City or Town of: YARMOUTH To the Inspector of Wires:
-� By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) Z) L,,A36 jy _) /I)
ZOwner or Tenant /leg �5 ,J'L Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes E No
❑ (Check Appropriate Box)
'i Purpose of Building Utility Authorization No.
Existing Service /OO Amps /ZL2/ 2`l Volts Overhead
Undgrd No.of Meters I
New Service Amps ElUnd Undgrd ❑ No.of Meters
g
Number of Feeders and Ampacity / Volts Overhead/—/0 b
t Location and Nature of Proposed Electrical Work: W/.r am 5'6-)7 17 c jm P `(-4L�}/Z.44,
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Completion of the followingtable may be waived by the Itsvector of Wires.
t ;; No.of Recessed Luminaires No.of Cell:Sasp.(Paddle)Fans No.of Total
r�! Transformers KVA
E-:",t No.of Luminaire Outlets No.of Hot Tubs Generators KVA
r ‘
i' No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grad. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
No.of Ranges No.of Air Cond. Total
Tons No,of Alerting Devices
No.of Waste Disposers Heat Pump I Number!Tons 1 KW - No.of Self-Contained
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection ❑ Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No.of Devices or Equivalent
Heaters ' No.of Data Wiring;
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
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 covers a is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:) C'O/Nl_ Ce= I /'X-Z/Z 3
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME:
��f LIC.NO.:
Licensee: h'$ / // t-� L7--v Signatur exq
(lf applicable,enter"exempt"m he license umber line.) LIC.NO.: J
Address: 6 CoV . /Z�J� f-V %2 f3j1- C�S'��72 /)1�� 026 ( Bus.Tel.No.•Tel. Y0f�-Z -/"J1 y
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lie.No.
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)0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE: $