HomeMy WebLinkAboutBLDE-24-966 6/20/24,6:42 AM about:blank
Commonwealth of Massachusetts , o4. YAK ,
* Town of Yarmouthti
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ELECTRICAL PERMIT �`"C,,gPpRATEO,b�rf%
Job Address: 5 SAMOSET RD Unit:
Owner Name: COOK STEVEN E
Owner's Address: P 0 BOX 667 Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-966
Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Mini split NC
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 0 No.of Devices:
Swimming Pool: ln-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 ❑ 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 0 Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: June 18, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: ROBERT A SOUSA License Number: 40596
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Osterville, MA, 026550014 Osterville MA 026550014 Fee Paid: $50.00
Email: Robertsousa34@gmail.com Business Telephone: 508-420-0785
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 UseQnly
t *_ Permit No.: G�-( `��
i -rt Department of Fire Services Occupancy and Fee Checked:
� el 4 BOARD OF FIRE PREVENTION REGULATIONS1
,c�:,— [Rev. 1/2023
''-cs'• 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: '.O ^ 16- z 'I
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): 5 5,,M dS A V4 5-. tl p4-"wu1' Unit No.:
Owner or Tenant: /4 ud)U_h/ S k ,N►,tiy 1,,t_._ Email:
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes ❑ No,® Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: J O o Amps /Gt' / 1'y> Volts Overhead] Underground❑ No. of Meters: f
New Service: Amps / Volts Overhead❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: /^ C f')rtvtsF 5f'/'77--
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. E Above-Grnd. 0 Hot-Tub 0 No. of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 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 SuSp p n�'"' ,, -
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level I ❑ Level 2 0 Lel, eating' __ D
OTHER:
JUN_18 2024
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When regiiF Ib9tith j di ivritiy T
Date Work to Start: Inspections to be requested in accordance with-IvtEe Role iu, and upon completion.
FIRM NAME: iRehM.. A COU jA J A-1 ❑ or C-1 ❑ LIC. No.:
Master/Systems Licensee: LIC.No.: /
Journeyman Licensee: ��,�t A ( LIC. No.: � 910 s `�6
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC. No.:
Address: FO 2 OLIr 19 O$f6.A.vt►k in 7() QL G.S"6
Email: Po.66nT 50✓�4 3 9 A4, a G 5 OL (��_071c
y 1'�`I �1'b _ Telephone No.: I�
I certify,u II .in penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: Re&4 .7)- A t 1"" Cell. No.:
INSURA CE C VERAGE: 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 f same to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER❑ Specify:
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.: