HomeMy WebLinkAboutBLDE-23-19027 6/28/23,3:59 PM about:blank
Commonwealth of Massachusetts og Y� ..
* „ Town of Yarmouth �11.4 Y `. �`
1' 0 �y
ELECTRICAL PERMIT ,A f'
Job Address: 31 CHECKERBERRY LN Unit:
Owner Name: SAMPSON ROGER M SAMPSON SIMON JODI ANN J
Owner's Address: 31 CHECKERBERRY LN Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19027
Existing Service Amps/Volts Overhead ❑ Underground 0 No.of Meters:
New Service Amps/Volts Overhead 0 Underground ❑ </ No. of Meters:
Description of Proposed Electrical Installation: Add-on A/CY. r
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: ' Type:
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: "N
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-Grnd.0 Hot Tub❑ 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 0 Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: June 28, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JAMES M VENUTI License Number: 15798
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: W BARNSTABLE, MA, 026681340 W BARNSTABLE MA
026681340 Fee Paid: $50.00
Email:jvenuti@mac.com Business Telephone: 508-428-7000
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:
about:blank 1/1
�� ('on,aromueat`tjs of Mamac/weetLy Official Use Only
cc77 �i Permit No. 9 /
. aptactmettl of 1 Jceu[ees /
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07),and Pee Checked
V (leave blank)
APPLICATION FOR PERFAIi €O PERFORM ELECTRICAL VtfO't [
All work to be performed in accordance with the Massachusetts Electrical Code(MEC).527 CAR 12.00
(PLEASE PRINT IN INK OR TIRE ALL INFORMATION) Date: L125123
City or Town of: Ye r m o 4/SY# To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number)31 c L u.i,e„.6,.„y INN
Owner or Tenant Telephone No.
Owner's Address
Es this permit in conjunction with a building permit? Yes 0 No ❑(Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: W,,t, d d
,4 ov-� A-lc, Cov7da✓,sw
Completion pf the followin toble may be waived by the Inspector of Wires.
No.of Recessed Luminaires INo.of Ceil:Susp.(Paddle)Fans No.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
grad. ,cud. Battery Units
No.of Receptacle Outlets No.of Oil Burners FlRE ALARMS INo.of Zones 1
No.of Switches No.of Gas Burners No.of Detection and I
st
Initiating Devices
No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices
No.of Waste Disposers 'Heat Pump 1.Number Fens FfW 'o.of Self-Contained t
Totals:I I I Detection/A€ertittg Devices
No.of Dishwashers Space/Area Heating KW Local❑ ction i Municipal
Conne 1-7
other
No.of Dryers Heating Appliances I,;F§ Seenrtty
No.of Weser No.of No.ofNo.of vices or Equivalent
Eeasets [sire Data Wiring:Signs Ballasts No.of Devices orEqyuivaient
No.F{ydromassage Bathtubs No.of Motors Total HPTelecommunications @Yirin
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired or as required by the Inspector of!Fires
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Stan: 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 cove ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE t'BOND 0 OTHER 0 (Specify:)
i ceriifr,under the pains and penalties oP )P j jury,that the information an this application is true and complete FIRM NAME: JQ-..:..)a A/1, I,� tt c1s.cir:'C.�,
`r LlC.NO.: [
Licensee: i- rj� ..j �1'. $ Y
'-) :.'m`-S .'ti1.1/c=n�%T7 SFgnature i� G-!!vr•//
(If applicable.enter"exempt"in the license number line.) n LFC.NO,:
Address: �C: T'os;cln S 2��� Bus.Tel.No.. Cii-,, c,p0'� ini:p.Sar,1 S'l a(,lc �6 Alt.Tel.No.SoE-biYc-5.3E.F
`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 ant aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below,1 hereby waive this requirement. I am the(check one owner owner's a ens.
Owner/Agent
^-� PERMIT FEE:$
Signature Telephone No.
=Ail Ai C-". ,,v"znut'i e t'rt«.c.Cc.'✓7