HomeMy WebLinkAboutBLDE-24-354 :00 AM
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`` Commonwealth of Massachusetts Y °�F,
*. he Town of Yarmouth
ELECTRICAL PERMIT1.;,rt ,�s
Job Address: 175 PINE GROVE RD Unit:
Owner Name: FARRELL DEBORAH R
Owner's Address: 87 BROWNS BEACH RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-354
Existing Service Amps/Volts Overhead❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead ❑ 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:
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 ❑
Y No.of Devices:
No.Air Conditioners: Total Tons: Telecom System ❑
Y 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 0 Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1,500 Work to Start: March 1, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JOHN M PIMENTAL License Number: 27968
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: EAST FALMOUTH, MA, 025365455 EAST FALMOUTH MA
025365455 Fee Paid: $50.00
Email:jmpinstaller@aol.com Business Telephone: 508-566-4472
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:
6f1S -5(4(2..,(4 r.
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Commonwealth of Massachusetts Officialate Use1y n On __ fd
Permit No.: ZL--( —
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��_ il-ft Department o f Fire
m1-= p J Services Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
""_.. 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,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): P l .i-'t tln�P C2 rove
�^. �/wt��, Unit No.:
Owner or Tenant: "Lt i 4 csi re-tt Email:
Owner's Address: • _ Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No ❑ Permit No.:
Purpose of Building: De/'�` ��� t
^ �'W� Utility Authorization No.:
Existing Service: Amps / Volts Overhead
❑ Underground g d❑ No. of Meters:
New Service: Amps / Volts Overhead❑ Underground g ❑ No. of Meters:
Description of Proposed Electrical Installation: t(Jt%i cY 5t.0'4t i)v ivki $ 4/ .515-r
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 0 No. of Devices:
Swimming Pool:In-Grnd. ❑ Above-Grnd. 0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System
No.Air Conditioners: Total Tons: Telecom
❑ No.of Devices:
lecom System❑ No. of Outlets:
No.Energy Storage Systems: KWH Storage Rating: SecuritySystem stem y ❑ No.of D vie —
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply EquiprieR E C E I V E D
No. of Modules: Roof-Mount❑ Ground-Mount❑ Level I ❑ Level 0 Level 3 ❑ Rating.—. • .. .' --
OTHER:
MAR 012024
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: t/Q7 8UILDING DEPARTMENT
(When required by tTlut�nlicy)Date Work to Start: 3-(—a/ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
FIRM NAME:
A-1 ❑ or C-1 ❑ LIC.No.:
Master/Systems Licensee:
n` 1 , I LIC.No.:
Jo
Journeyman Licensee: hn �/ y� �)9��r
LIC. No.:
Security System Business requires a Division of Occupational Licensure"S"LIC.
S-LIC. No.:
a
Address: 1 _ (�t�j ,t MA
Email: S 1-e r, tiJ(�V� E� 5�� Io
r co Yt� _ Telephone No.: �V? 5(��
I certify,u d he • ndpenaltie o [f perjury,that the information t this applicati n is true and complete.
Licensee: Print Name: Sfvtih r,1441
INSUR CE COVERAGE: Unless waived by the owner,no permit for the performance of electrical workll.may issue�ness thelsiR
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. licensee
CHECK ONE: INSURANCE ❑ 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: requ g
Signature:
Tel. No.:
Email.: