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Commonwealth of Massachusetts �of Y1�
Town of Yarmouth
ELECTRICAL PERMIT .f
Job Address: 24 GRANT RD Unit:
Owner Name: GERVELIS KATELYN
Owner's Address: 24 GRANT RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.: 16643479
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-437
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead 0 Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Service upgrade
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 0 Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 0 Work to Start: March 19, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: DAVID R NICOLL License Number: 37557
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: S YARMOUTH, MA, 026641038 S YARMOUTH MA 026641038 Fee Paid: $50.00
Email: dnicoll5@comcast.net Business Telephone: 508-360-7313
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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1-`- ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 Q44 12.00
(PLEASE PRINT IN INK OR TYPE-ALL INFORMATION) Date: MARCIk ri t eI
City or Town of: N1I OUTIA- To the Inspector of Wires:
By this application the undersigned gives notice of ofhis or her intention to perform the electrical work described below.
Location(Street&Number) a21 (�'W',T RD
Owner or Tenant PCTC t tin t t i-M Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No e (Check Appropriate Box)p
Purpose of Building Utility Authorization No. ` 0134i79
Existing Service 100 Amps go 010 Volts Overhead C?J Undgrd 0 No.of Meters I
New Service aC>C" Amps taO/alt.Volts Overhead G' Undgrd 0 No.of Meters I
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: E 2v<)CE- C'“
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Abo a m- No.of Emergency Lighting
No.of Luminaires Swimming Pool ` ❑ Igrr,d❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
ofand
No.of Switches No.of Gas Burners No.In Detection
Initiating Devices
No.of Ranges No.of Air Cond. Ton No.of Alerting Devices
No.of Waste Disposers Heat Pump_Ngpttlgr_ Tons.1__KW No.of Self-Contained
Totals: I Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal-
unicipal ❑ Other
Connection - •
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water No.of No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired ores required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start 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 cov rage is in force,and has exhibited proof of same to the Pert issuing office.
CHECK ONE: INSURANCE A., BOND 0 OTHER 0 p ify:) / Ct hi co II 5')cnmcgs-(--.v.e.i-
I certify,under the Akins and penalties of petjury,that the inf. 'non tit,applicatio. '. send c
FIRM NAME: ✓O U) NkCo tit. ` ���I I. ,NO.. 31557 E
Licensee: Si: :,,, ,t e♦ LI ,NO.:
(If applicable enter"exempt"in the license number line.) Bus el.No.: 5og-349-16T..31
Address: 144 bit fTW00.t UY_ SNIatiVC(kt Mk OL61 t.Tel.No.:So$-36b•73L3(au)
*Per M.G.L.c.147,s 57-61,security work requires Department of Public Safety"S"License: Lic.No.
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does nor have the liability insurance coverage normally
required by law. By my signature below,I hereby waive this requirement. I am the(check one) 0 owner ❑owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$