HomeMy WebLinkAboutBLDE-23-15869 �� Commonwealth of Massachusetts -oF -441)
* Town of Yarmouth ,a, .' . C
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' ELECTRICAL PERMIT '� tax
Job Address: 412 ROUTE 28 it
Owner Name: CARLSON KEITH F EDMOND SHAMI/ OLLY TREE TRUST)
Owner's Address: 412 ROUTE 28 Ph e: % Email:
Purpose of /
Building Commercial Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15869
Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
New Service Amps/Volts Overhead 0 Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Install two receptacles in basement '' /
No.of Receptacle Outlets: 2 No.of Switches: Generator KW Rating: O
No. Luminaires: No.of Recessed Luminaires: No.Wind Generators: /sspit,„‘,..,0.
'
No.Appliances: KW: No.Water Heaters: KW: No.Transformers:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total Q 0.-.?
No. Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool: In-Grnd.❑ Above-Grnd.❑ Hot Tub 0 No.of Self-Contained Detection/Alerting Devices: a
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 0 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount El Ground-Mount 0 Level 1 El Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 500 Work to Start: May 17, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ZACHARY MANCINI License Number: 57951
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: YARMOUTH, MA, 02673 YARMOUTH MA 02673
Email: ztmancini@gmail.com Business Telephone: 617-429-9070
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:
�._ Commonwealth of Massachusetts Official Use Only_,
�
Permit No.: E.23 —(c (,`i
_:::t Department of Fire Services Occupancy and Fee Checked: t
li� BOARD OF FIRE PREVENTION REGULATIONS• [Rev.I/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:
To the Inspector of Wires:By thi ''jjpylication•the u dersig gives notices of his yr her intention to perform the electrical work described below.
Location(Street&Number): j/i f 7/( Ft 0! ,At/• �w " Unit No.:
Owner or Tenant: //�y� \Z -?. Email:
Owner's Address:�l p/�,Q l�I�/f r o • ` a"--A w"-h Phone No.:9$ ?7( 66 17
Is this permit in coniungtlgn with a building permit?(Check appropriate box)Yes El No O'�ermit No.:
Purpose of Building: / Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
New Service: Amps / Volts Overhead Di Underground El No.o/-of Meters:
. Description of Propo d EI trical Insta�ati q: et,,,,,,,5.
Z C1e/lvge a OqLlq lCa4c/ 'n
/k Gb,aii 'li a/aye a,f-ile
Completion of the following table may be waived by the Itor of Wires.
No.of Acceptable 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-Grad.0 Above-Gmd.❑ 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❑ Ground-Mount❑ Level I❑ Level 2❑ Level I v
OTHER: - +
.4- l .
Attach additional detail if desired,or as required by the Inspector of Wires. MAY 17 2023 i
Estimated Value of Ele trical Work: e CD (When requ' by unicipal policy) .J I
Date Work to Start:5—7/7 3 Inspections to!be uested in accordance with ME Itltlel-RIN�itd't '6�tt�lOWiptaiolt.
FIRM NAME: ; ✓"lfvL' 6&...< 1/LIL✓\ A-1❑or 'ey/ IC.No.:
Master/Systems Licens • LIC.No.:
Journeyman Licensee:7;(/gtty To AD AO t LIC.No.:5-?Yr/—/3
Security System BBusinnesss rquirr%aa,Division of Occupational icensure"S"LIC. S-LIC.No.:
y �Y
Address: r/y g-C • lam✓- `�Ai �
Email ail-a./I ip l i1?a i(- Co vh • Telephone No.: ,/1 Le.zct L�i
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I certify,under e an penaltles of perjury,that thformation on this application is true and complete.
License e.-a� Print Name:ra �C,iU�/I r Cell.No.:6/7 L/L 9 e(O76
INSURANCE COVERAGE:Unless waived by the owner,no permit r the performance of electrical work may issue unless the licensee
provides proof of liability including"co pleted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of a to the permit issuing office. I , ( ` ,�
CHECK ONE: INSURANCE BOND El OTHER 0 Specify: `l-.(/ O'^�-Y v
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not ave the liability insurance coverage normally
required by law.By my signature below,I hereby waive this requirement.I am the:(Check one)Owner 0 Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.: