HomeMy WebLinkAboutBLDE-23-19837 11/14/23,6:54AM about:blank
Commonwealth of Massachusetts o Y y�.
yi444* �, Town of Yarmouth � � '
ELECTRICAL PERMIT
Job Address: 22 &24 MANOR PATH Unit:
Owner Name: VOOS KAREN W TRS KAREN W VOOS REV TRST
Owner's Address: 1169 LONG HILL RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19837
Existing Service Amps I Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Relocate distribution panel w�G .( (`=iy. i,c
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: G /T`y�pe:
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 15, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: DANA K OTIS License Number: 27163
Security System Business requires a Division of Occupational Licensure
"S" LIC. . License Number:
Address: ORLEANS, MA, 026534013 ORLEANS MA 026534013 Fee Paid: $50.00
Email: danaotiselectric@gmail.com Business Telephone: 774-212-0160
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the
licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
INSURANCE:
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' NOW 2023 Official Use Or*
ommonwealth of M• assachusetts Permit No.: 23 I_( wJ y 7
gU . rG_->dl �'..':"I E NT Department of Fire Services Occupancy and Fee Checked:
`jY - ./-- BOARt OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
y�' 14, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH • Date: ///,9
To the Inspector of Wires:By this application,the undersigned giv s not'ces of his or her intention to perform the electrical work described below.
Location(Street&Num r): Unit No.:
Owner or Tenant: Act r P 4 -91-c Email:
Owner's Address: „Panne,. Phone No.: N tJ`3 -(w L,-6'` t:' / -J
Is this permit in conjunction with b ilding permit?(Check appropriate box)Yes El No E'1'ermit No.:
Purpose of Building: Sf1 f( a4" j-Im Bi t e. Utility Authorization No.:
Existing Service: i/$& Amps/„'! 1 Rico Volts Overhead J, Underground❑ No. of Meters:
New Service: Amps / Volts Ovej head El Underground❑ No.of Meters:
Description of Proposed Electrical Installation: Re j cod__ toonPL 6,941 orh 13• rG-/700 1 1 KR # Ad92h MI.
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: 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: _
OTHER:
Attach additional detail if desired,or as re u'red by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: //''45%"..ad Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 404 Q,>t'ts' &Ldrifc,; A-1 0 or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: f ...?y"163 LIC.No.:
Security System Business requires a Division of Occupationa Licensure"S"LIC. �S-LIC.No.:
Address: /,G. (/J�' ■,,,,k / 6e�.- R. c o �f 4M aR 6 3
Email: q c7frF el e-G r Telephone No.: 7,7y-,wp? ma
I certify,under the pains nd penalties of perjury,that the information onnthis
application is true and complete.
•
Licensee:� /� jA Print Name: 2 ,c) 34 c ✓ ` • Cell.No.:
INSURA EE�OVERA E: Unless waived by the owner,no permit for t e performance of electrical work may issue unless the licensee
provides proof of liability including"com leted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of s e to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER❑ Specify: A
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.: