HomeMy WebLinkAboutBLDE-23-15843 \c‘ Commonwealth of Massachusetts 1 �„A °F,
* Town of Yarmouth 0
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ELECTRICAL PERMIT '
Job Address: 14 CAPT BLOUNT RD Unit:
Owner Name: CROSSLEY BARRY CROSSLEY MARIETTE
Owner's Address: 28 WINDING BROOK RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15843
Existing Service Amps/Volts Overhead ❑ Underground ❑ No.of Meters:
New Service Amps/Volts Overhead❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: Replacement boiler
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❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: 1 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❑ Level 1 0 Level 2❑ 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: Leon Knight License Number: 20979
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address:
Email: leon@knightelectricma.com Business Telephone:
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:
407
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RECEIVED
1 Official UscOnly
10 202aCom onwealth of Massachusetts PermitNo:(=Z3— / c' 3
>r f D-a artment of Fire Services Occupancy and Fee Checked:
fr-"BOARDL F IRE PREVENTION REGULATIONS [Rev.1/2023]
APPL •TION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C 12.
City or Town of: YARMOUTH Date: r /0 2-3
To the Inspector of Wires:By this application, a and ned Ives not as a his or her i tion to perform the electrical rk de below.
Location(Street&N bar):�i7 //` n /�/ _ Unit No.:
Owner or Tenant: e / t� Email:
Owner's Address: / Phone No.:
Is this permit in conjunction wr a building permit?(Check appropriate box)Yes❑ NoPermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead D Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electr.ca1 Installation:
Completion of the following table may be w ed by the nspec or 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 0 No.of Devices:
Swimming Pool:In-Grnd.❑ Above-Gmd.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 Supply Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1❑ Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: Inv ectio s to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 44f f A9 !sr r- /ye,,/n e A-1 0 or C-I❑LIC.No.:
Master/Systems Licensee: f a°6,� �/74�� LIC.No.: 4'���ri
Journeyman Licensee: J LIC.No.:
Security System Business r uir/ees a Division of
Occupational Licensurecens ",S""LIC. S-LIIC..No.:
Address: 9 ,/7/" (CTV �j^`/✓�4 rv263/
Email•<CeJ�� ' kt e�'b'M Telephone No.:
I certify,under the pains d penalties of perjury,that the information on this application is true and complete.
Licensee:/e.,evi N in��� Print Name:_Sp9 R-f�'�6,3 7/ Cell.No.:?'744 72 T/23 INSURANCE CO V RA nless waived by the owner,no permit for the perform ce of electrical work may issue unless the licensee
provides proof of liability inclu mg"completed 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.
CHECK ONE: INSURANCEBOND 0 OTHER 0 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 0 Owner's agent❑
Owner/Agent:
Tel.No.:
Signature: Email.: