HomeMy WebLinkAboutBLDE-23-15967 6/1/23,6:30 AM about:blank
Commonwealth of Massachusetts o Y
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Town of Yarmouth '
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ELECTRICAL PERMIT `
Job Address: 12 WADSWORTH LN Unit:
Owner Name: LARNED RICHARD E LARNED NANCY JEAN
Owner's Address: 12 WADSWORTH LANE Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15967
Existing Service Amps/Volts Overhead ❑ Underground 0 No. of Meters:
New Service Amps/Volts Overhead ❑ Underground ❑ No.of Meters:
Description of Proposed Electrical Installation: Replacement 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:
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: 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 31, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JULIAN ROBINSON License Number: 58376
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: MARSTONS MILLS, MA, 02648 MARSTONS MILLS MA 02648 Fee Paid: $50.00
Email:julianrobinson46@gmail.com Business Telephone: 774-368-0824
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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� Permit No.: GZ3 i S 'd fn 7
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artment of Fire Services Occupancy and Fee Checked:
14= -# BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
•v," 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:
To the Inspector of Wires:By this application,th undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): t �. I✓cti Ls wOir r✓bW l� Unit No.:
Owner or Tenant: Al c,t4 c y i—c, k t - Email: 4/ L. c t rr et e c 2 e C-,kt fac L . C-N
Owner's Address: t t,., tv(Q;S f•,ov--It, (....(-.(-0 2_ Phone No.: 7 7`l-t q y_ 7 3 Sr 7
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: e P i---"(--- I Li 141 Utility Authorization No.:
Existing Service: ') b. 6 Amps Iai / (DVolts Overhead❑ Underground No. of Meters: I
New Service: Amps / Volts Overhead❑ Underground No.of Meters:
Description of Proposed Electrical Installation:ll (Le P(c,c t ' S S c pf(IC Re V S't-,3 u t . L G.'- �,vo S
P 'C .e -f-b s-e p f L J.eC.. ►,5 1Afe L' p v c,.ic,'-t k A(c tM
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: f 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: I Total HP: Z Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.0 Hot-Tub El — 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 0 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 0 Ground-Mount 0 Level 1 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrica)_ Work: I b 00 (When required by municipal policy)
Date Work to Start: `7/3 ((2&2 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: S y l V 14 G v�t ur A-1 0 or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: J (,'1'. t h Rob i Lic'i LIC.No.: S $' 3 74. - i3
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: �� S �.., f v i l.' Iv (��
Email: v(; wt 11y01 ;iisr., 146 L.6t,,-t t f , C,oi
'"1 Telephone No.: 77 - SGY- G ry Z
I certify,and the ains and penalties,( of perjury,that the informationin on this application is true and complete.
Licensee: _ �L�'a"' Print Name: ,/ V i; t„ I\ G`r t-fb - -O� Cell.No.: ? �� 3�� y z U INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee 7
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.
CHECK ONE: INSURANCE I1 BOND❑ 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❑ Owner's agent Owner/Agent:
Tel.No.:
Signature:
Email.: