HomeMy WebLinkAboutBLDE-24-145 -- 1/29/.4.2:34 PM . if
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' - 1p Commonwealth of Massachusetts . of y`4
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Town of Yarmouth . ::ytit`, t C
? MA ACNE£SE .''• ELECTRICAL PERMIT `` . .
Job Address: 1 AUNT EDITHS RD Unit:
Owner Name: BRODERICK PETER R BRODERICK HOLLY A
Owner's Address: 1 AUNT EDITHS RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-145
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: Receptacles, heat, & light to existing shed.
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 E 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 0 Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: January 29, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: License Number: 4 Ste, 744,7
Security System Business requires a Division of Occupational Licensure 3 '
"S" LIC. License Number:
Address: Fee Paid: $75.00
Email: Business Telephone:
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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�c�A ��''tt ((, Permit No. /�-2���`t'
2eparimeni oI.}iim leraices
,� Occupancy and Fee Checked
i BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave k)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
ft All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: {�,Z
City or Town of: l ,(IAA o L h tom- To the Inspector d rr�s:++ r 1 `,
V By this application the undersigned gives notice of his or her intention to perform the electrical*So ' enbEdbelawY LJ
Location(Street&Number) 4 UNr L t� cz4(
Owner or Tenant .C.,< Te epYoeaIl� 2 9 2i24
1
Owner's Address 'Wt,t' ,Ij'�v.S L---. - I
rsui�umt,UH�'q RTMENT
Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Clio
ApproprWe =L
4 Purpose of Building \i`,t C i‘,;�.;h-`-c-, Utility Authorization No.
I Existing Service Amps / Vohs Overhead❑ Undgrd❑ No.of Meters
�`�,N, New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Ni% Number of Feeders and Ampacity /
Location and Nature of Proposed E1WMeal or k: �,S'-CS, j C/"r. )0i47 /�-t 54 6
VI Completion of the following table may be waived by the inspector of Wires.
Vi
W P No.of Recessed Luminaires No.of Ceil.-Sus .(Paddle)Fans No.of Total
Transformers KVA
C` No.of Luminaire Outlets No.of Hot Tubs Generators
KVA
`` Above In- No.of kmergency Lighting
ti No.of Luminaires Swimming Pimi grad. ❑ grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
1 No.of Ranges No.of Air Cond. Total No.of Alerting Devices
' rs Heat Pump _Number, Toes KW__ No.of Self-Contained
No.of Waste Di
sposers Totals: I Detection/Alerting_Devices
No.of Dishwashers Space/Area Heating KW Local❑Connection 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
ry No.of Devices or Equivalent
No.of Water (, No.of No.of Data Wiring:
Heaters Signs Ballasts No.of Devices or Equivalent
No.H dromassa aBathtubs No.of Motors Total HP 'Telecommunications Wiring:
Y B No.of Devices or Equivalent
OTHER:
Attach additional detail ifdesired.or as 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 coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the information application is true and complete.
FIRM NAME: �(/ LIC.NO.:
Liaesi!!: C)LOT(�/4, Signature ",""JGI~ LIC.NO.:
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.'
Address: Alt.TeL No.:
*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 not 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 0 owner's agent.
Owner/Agent Telephone No. PERMIT FEE:$
Signature P
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