HomeMy WebLinkAboutBLDE-23-15833 Commonwealth of Massachusetts o Y
* Town of Yarmouth
ELECTRICAL PERMIT
Job Address: 'Z STAN pis, UJ Unit:
Owner Name: 1=L1gA en: l�uA-/
� t-RJ
Owner's Address: Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15833
Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
New Service Amps/Volts Overhead 0 Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Install mini split system.
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: 1 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: 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: $ 1,000 Work to Start: May 12, 2023
FIRM NAME: Robies Refridgeration License Number:
Master/System and/or Journeyman Licensee: Charles Swanson License Number: 12895
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address:
Email: rachael@robies.com Business Telephone:
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:
q3
RECEIVE ®
-- ,_._- o monwealth o/Maeeachueelfe Official Use Only
4'►- Y 5 2023 �] Permit No.
0----itiiM 1 eParIntent o/. ire Services
� Occupancy and Fee Checked
_ BOAkn O EIf E PREVENTION REGULATIONS [Rev. 1/07] (leave blank)
APPLICATION 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: 5 1%123
City or Town of: Ya.rmouukiA 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) (02 Stand.iSIA Wel
Owner or Tenant Evzcooti& enkiest Telephone No.
p 620 3b5-'oil
Owner's Address
Is this permit in conjunction with a building permit? Yes n
t l No rg (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead n Undgrd g rl No.of Meters
New Service Amps / Volts Overhead n Undgrd g n No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Vki"1o§ Mit\- SQhk. m S��S+e
Completion of the following table may be waived by the Inspector of Wires.
u No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total
Transformers KVA
v' No.of Luminaire Outlets No.of H T
�' Hot Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- No.01 Emergency Lighting
grnd. grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones
V 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 I r l Tons I KW No.of Self-Contained
Totals: 1 Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
1 Connection Other
No.of Dryers Heating Appliances KW 'Security Systems:*
No.of Water of No.of Devices or Equivalent
No. No,of
Heaters KW '.data I,Vir ins:
Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER:
No.of Devices or Equivalent
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
fdo (When required by municipal policy.)
Work to Start: 5(t2 23 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 co rage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE al BOND ❑ OTHER
❑ (Specify:)
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: bie S HectF* e ( i
� / LIC.NO.: gy(gp Al
Licensee: (�\ c , K, 5 sor\ Signature,!, — G✓
(If applicable,enter "exempt"in the license number line.) LIC.NO.:
Address: 2']Q ,{arm t N aW'S Bus.Tel.No.: 50$-775'3°83
Tel.No.:
*Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a•ent.
Owner/Agent
Signature Telephone No. 1 PERMIT FEE:$