HomeMy WebLinkAboutBLDE-24-671- 4/25/24,3:03 PM about:blank
Commonwealth of Massachusetts
r Town of Yarmouth
O
ELECTRICAL PERMIT
Job Address: 16 CHURCH ST Unit:
Owner Name: LEVINE HAROLD
Owner's Address: 16 CHURCH ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-671
Existing Service Amps /Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps /Volts Overhead ❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: Replacement furnace & heat pump.
No.of Receptacle Outlets. 1 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: 1 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: 1 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: April 24, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: RICHARD T MCKENZIE License Number: 28006
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: SOUTH DENNIS, MA, 026602359 SOUTH DENNIS MA 026602359 Fee Paid: $50.00
Email: richmckenzie55@yahoo.com Business Telephone: 508-776-3361
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 91fisial li se Opl
Permit No.: —
I E--.50. ' Department of Fire Services Occupancy and Fee Checked:
C-:e �—i 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 CMR2-*/12.00
City or Town of: YARMOUTH_ Date: :2� - 2
To the Inspector of Wires:By this appliccaatiioo',the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): /6 CA di'e%. �5 Unit No.:
Owner or Tenant: P. ,t,- <1.22uLia..- Email:
Owner's Address: ,Sa./ir e Phone N
Is this permit in conjunction�' L.a building permit?(Check appropriate box)Yes❑ No ermit No.:
Purpose of Building: e6/0,4 C Utility Authorization No.:
Existing Service: _,Ver, Amps /16) / 74V Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
. Description of Proposed Electrical Installation: "7,/,(04,_ /4.;:✓ C_-- 71- yre.�71 ?C. LY-ea
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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.0 Above-Grnd.❑ Hot-Tub 0 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 0 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 0 Ground-Mount❑ Level l 0 Level 2 0 Level 3 EI ljisitit c E I V
OTHER: e�i` .. �_
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Attach additional detail if desired,or as required by the Inspector of Wires. APR 2 52021
Estimated Value of Electrical Work: (When required by muLcipal policy)
Date Work to Start: �j - Z4- Inspections to be requested in accordance with MEC R lot aria uponcom, a T
FIRM NAME: 4i4,- ' 7 zq ,v71� �y /'ejQ„v A-1 0 or C-1 0 LIC.No.: �^
Master/Systems Licensee: LIC.No.: 4-02,ai)d
Journeyman Licensee:, e "74 e.v2L LIC.No.:
Security System Business requires a Division of Occupational/J Licensuren\ "S"LIC. S-LIC.No.:
Address: -�.7 �i �i/$Gi
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Email: /'/(' t J 2,VZ.//�' j-a GJ.(A0-0 - Gd-hL _ Telephone No.: 1-77/-33e/
I certify,under :e pains and penalties of perjury,that the infor 'on on this dietitian is true and complete.
Licensee: /el , 4.s tV2/cite--- Print Name /1� Cell.No.: 5� 77Z--. 4/
INSURANCE COVERAGE: Unless waived by the owner,no permit for the perforice 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 s to the permit issuing office.
CHECK ONE: INSURANCE[BOND❑ OTHER El Specify:4... f�* `J..Z
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.:
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