HomeMy WebLinkAboutBLDE-23-19346 8/16/23,8:46 AM +, about:blank
( 19 Commonwealth of Massachusetts o Y aa,
Town of Yarmoutht� 0 ;
ELECTRICAL PERMIT ` /
Job Address: 37 UNION ST Unit:
Owner Name: GROCE ROJAE
Owner's Address: 37 UNION ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-23-19346
Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
New Service Amps I Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Finish basement&walkout.
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: 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: $ 1,500 Work to Start: August 16, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: License Number:
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Fee Paid: $250.00
Email: Business Telephone: .0 e. P[S"- 75 a 0
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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__ Commonwealth of Massachusetts Official Use Only 1
t- Permit No.: _
lip_grt Department ofFire Services Occupancy and Fee Checked:
. —: 1— P p Y
e— BOARD OF FIRE PREVENTION REGULATIONS l 1/2023] j
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-,-. o- 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: ice• II. �3
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& umber): aq (AA t bvi% S - Weft Mat,tJ41„O�,Lt Unit No.:
Owner or Tenant: Number):
C pc I Email:l �!OHO 3t e—, �.
Owner's Address: v (3- (,tvlt 6 A 51-mc r W Al
Phone No.: `5��'�/6`_7,57, D
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No❑Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
Description of Proposed Electrical Installation: P(2(.X''i l(.t,A. t p{,iL 1‘A. f ' N ,AvAlc-o k-
Waft fin sh / r ij
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: — 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❑ No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Grnd.❑ Hot-Tub 0 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 Y stem
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 0 Level 3 0 Rating:
OTHER:
.............
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: i tiSt.,o , c�
Date Work to Start: (When required by municipal policy) •
Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee:
LIC. No.:
Journeyman Licensee:
LIC. No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email:
Telephone No.:
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name:
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
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❑ BOND❑ OTHER❑ Specify:_
,OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance overage normally
resit : 1 by law.B my signature below,I hereby waive this requirement. I am the:(Check one)Owner[Owner's agent
Owner 'Agent: K 0o g
Tel.No.:�c t�- ` `jam
Signature:
—____-- Email.: f 0 c e‘O�4 a ti'I�A. 1-os'M
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