HomeMy WebLinkAboutBLDE-23-19358 8/18/23,6:00 AM about:blank
4' v Commonwealth of Massachusetts of • 1(-4.4,,'
*� ; �1)`" Town of Yarmouth • i. o.,
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ELECTRICAL PERMIT t f
Job Address: 65 PHYLLIS DR Unit: 7 7 - 7 2-2 - ( -3 il
Owner Name: FOGG HANNAH M FOGG STEVEN E I
Owner's Address: 65 PHYLLIS DR Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-23-19358
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Bathroom Remodel
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 El 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 ❑ No.of Outlets:
No. Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar i)V KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount El Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 75 Work to Start: August 22, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JAMES . FOGG License Number: 56124
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: HARWICH, MA, 02645 HARWICH MA 02645 Fee Paid: $75.00
Email: Jameswalterfogg@gmail.com Business Telephone: 7747221743
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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Commanwaa/h o`rr/aeeac(iaeeiis Official Use Only
:.-t at-: t r� [7 Permit No.
"--:IN.� h 2aparGnani of 5ire�Jrrvicee
f.H'.. HT Occupancy and Fee Checked
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
I (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
City or Town of: ei cMO L)r'e To the Inspector of Wires:
By this application the undersigned gives noticen o`f his or her intention to perform the electrical work described below.
__; (
Location(Street&Number) o Y
S ks `,l 5 1)f
Owner or Tenant Stek3 en O OA (r,U.)(\e" Telephone No.1 i -l 2'1-I%3'
`y i Owner's Address (p 5- t i S d r.
- Is this permit in conjunction withI •bui(lyding permit? Yes s� No ❑ (Check Appropriate Box)
qj Purpose of Building D k.j ul i n ry Utility Authorization No.
• Existing Service I Amps I E'/ U,OVolts Overhead Ei Undgrd❑ No.of Meters 4
New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity '
Location and Nature of Proposed Electrical Work: t a-M1 /�r8pm 1< 06.e.1
vi Completion of the following table may be waived by the l,tgector of Wires,
Total
I4Z.) No.of Recessed Luminaires No.of Ceil:Sns .(Paddle)Fans No.of KVA
P Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
iQ. Above In- No.of Emergency Lighting
k No.of Luminaires Swimming Pool grad. 0 grnd. 0 Battery Units
. �l 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
11.1 No.of Ranges No.of Air Cond. Tons
No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons•_ KW No.of Self-Contained
P Totals: -" Detection/AlertinaDevices
No.of Dishwashers Space/Area HeatingKW Local 0 Municipal O other
P Connection
No.of Dryers Heating Appliances KW Security
Devices s or Equs:* ivalent
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 No.of Devices or 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 0 BOND 0 OTHER 0 (Specify:)
I certify,under the pains and penalties of perjury,that the Information on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: Signature LIC.NO.:
(lfapplicable,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 i urance coverage normally
required by law. B my signature below ereby waive this requirement. I am the(check one)nowner 0 owner's agent.
Owner/Agent i �,
Signature Telephone No.11 Lelad K 3i PERMIT FEE:3