HomeMy WebLinkAboutBLDE-23-15863 VE)
Commonwealth of Massachusetts -oc • .4„1;.
* A Town of Yarmouth
ELECTRICAL PERMIT ,F
Job Address: 43 CARRIE LN Unit:
Owner Name: CHURCHILL FREDERIC E CHURCHILL MARGOT D
Owner's Address: 243 PLEASANT ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-23-15863
Existing Service Amps/Volts Overhead 0 Underground 0 No. of Meters:
New Service Amps 200/Volts Overhead 0 Underground 0 No. of Meters:
Description of Proposed Electrical Installation: New residence JG , l`z- i �9 . 1
. n[C�t�'
No.of Receptacle Outlets: No.of Switches: Generator`KW Rating: `" Type: I
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 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❑ Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: May 17, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ANDREW M LEVESQUE License Number: 17318
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: HARWICH PORT, MA, 026461831 HARWICH PORT MA 026461831
Email: rachael@hphcllc.com Business Telephone: 508-432-3959
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:
"� � C64
) �C I,'�IP < t I u�z3
I-F -.C. E1vED
i r
r r Co mmomuaan o` ya maciutiatta Official Use Only
MAY 1 6 r. •Ail_�t c7 Permit No. 2'—(9S 43
1 31__ E 2).partmenl of Jiro Serviced
u t)I Nv U L„ _ Occupancy and Fee Checked
t�
.A BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
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:5/12/2023
City or Town of: Yarmouth To the Inspector of Wires:
Location(Street&Number)43 Carries Lane
Owner or Tenant Churchill Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑■ No ❑ (Check Appropriate Box)
Purpose of Building residential Utility Authorization No.12947921
Existing Service Amps / Volts Overhead❑ Undgrd E No.of Meters
New Service 200 Amps / Volts Overhead❑ Undgrd❑■ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: service and wiring for new single family dwelling
Completion of the followinyytable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans T of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
and
No.of Switches No.of Gas Burners No.of Detection on Devices
No.of Ranges No.of Air Cond. To
No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
P Totals: ... ..._...................... Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑Monnectionunicipal ❑Other
C
No.of DryersHeating 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 Nceor Equivalent
No.of Devices Equivalent
OTHER:
Attach additional detail if desired,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® BOND ❑ OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this application is true and complete
FIRM NAME: Harwich Port Heating and Cooling LIC.NO.: 593 Al
Licensee: Andrew Levesque Signature --�� ---- LIC.NO.: 17318A
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address: d/,t Inwerenunrg Rd Narudrh Port Ma 111ld/. Alt.Tel.No.: 5"84323139
°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)❑owner ❑owner's agent.
Owner/Agent
Signature Telephone No. I PERMIT FEE:$180
Please contact rachael@hphclle.com if you have any questions