HomeMy WebLinkAboutBLDE-24-485 3/26/2, 3:41 PM ` about:blank
'41fL\ Commonwealth of Massachusetts ,oF • Y �
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ELECTRICAL PERMIT //'
Job Address: 12 MERGANSER LN Unit:
Owner Name: CARBUNARI BETTY
Owner's Address: 12 MERGANSER LN Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-485
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Panel change, basement remodel & relocate washer /dryer.
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.El Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System El 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 0 Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 3,500 Work to Start: March 25, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: PAUL M DUNN License Number: 15825
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: SAGAMORE BCH, MA, 025622307 SAGAMORE BCH MA
025622307 Fee Paid: $75.00
Email: pauldunnelectrician@gmail.com Business Telephone: 774-338-1414
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 Official yse n y
Permit No.: e� — �
I-.fit- Department of Fire Services Occupancy and Fee Checked:
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(.= 1° 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: '3 --'Z�_ aL(
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 ''u Ir 5 e r Unit No.:
Owner or Tenant: D D r\C. V \ 0 V'l-Cg el Ol Y. \ Email: ?Irk ck.w vk ‘ 63 G `, b 0 • eue--,
Owner's Address: ne No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes No❑ Permit No.:
Purpose of Building: c_ ( Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
New Service: Amps / Volts Overhead1 ❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: ?[AV\c \ C.V\e.—Q'(1�-(P �7�5P WI A.k- '��r''C' \e?
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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.❑ Above-Grnd. 0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devi.... y
No.Oil Burners: No.Gas Burners: Video System 0 No. of Devices: EC
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No.Air Conditioners: Total Tons: Telecom System 0 No. of Outlets: i No.Energy Storage Systems: KWH Storage Rating: Security System El No.No.of Devices: MAR `•5 2024
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: i
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level I ❑ Level 2❑ Level 3 0 Rating: 1 •3 jT olNG r)EPA 2TMENT
OTHER: By --
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: " , ' ? G (When required by municipal policy)
Date Work to Start: ? -.f ().9 Inspections to be requested in accordance with MEC Rule 10, and upon completion.
FIRM NAME: \ 0`..1 \ Q S V\i^ A-1 0 or C-1 ❑ LIC. No.:
Master/Systems Licensee: LIC.No.: 37(3 1
Journeyman Licensee: LIC. No.: j- 1 S �c.,
Security System Business requires
a Division of Occupational Licensure"S"LIC. S-L1C.No.:
Address: - c a \- 1 AA° v' iLL
Email: `c�.. ( (A.VRer\- Q -f.Lfrl(_l4 '" R.iJ M4 , I . (....,, P"tTelephoneNo.: 77 `" 3,2& I f- I V
I certify,under the pains and penalties of perjury, that the information on this application is true and complete.
Licensee:?el, \ '1)U 4\ (-- . Print Name: \ \ " - rk 'c\ Cell.No.: 7 71f 3.3% (
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance 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 sam the permit issuing office.
CHECK ONE: INSURANCE OND ❑ OTHER❑ Specify: Q no z -/ I ' 4 t
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not he 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 0
Owner/Agent: Tel.No.:
Signature: Email.:
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