HomeMy WebLinkAboutBLDE-23-19001 si27/2'' 6:25 AM about:blank
Commonwealth of Massachusetts ogp4
* Town of Yarmouth - 11141.:77 °c'
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ELECTRICAL PERMIT ',`
Job Address: 160 WOOD RD Unit:
Owner Name: 114 UPPER COUNTY LLC
Owner's Address: PO BOX 1210 Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit.Number: BLDE-23-19001
Existing Service Amps/Volts Overhead 0 Underground 0 r No.of Meters:,>
New Service Amps/Volts Overhead 0 Underground 0 No.r of Meters: , 6
Description of Proposed Electrical Installation: Mini split systems (X2) /14:; '44
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: In-Grnd.❑ 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: 1 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 26, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JACK W GRIFFIN License Number: 418
Security System Business requires a Division of Occupational Licensure License Number:
"S" LIC.
Address: S YARMOUTH, MA, 026641339 S YARMOUTH MA 026641339 Fee Paid: $50.00
Email:jackgriffinelectric@comcast.net Business Telephone: 978-479-2521
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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RECEIVED xx
JUN 2 6_2023 Official Use qq Qe
comm n ealth of Massachusetts Permit No.: (�L�j V-3 b
q-_- i.Lc DING DEPNR
_1/r-�, Doi ment of Fire Services Occupancy and Fee Checked:
--=41— :• -a • - PREVENTION REGULATIONS [Rev.1/2023]
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 C 12.00
City or Town of: YARMOUTH Date: )/ .26 d3
To the Inspector of Wires:By this application the�unders�igned gives notices of his or her intention to perform the electric/al work described below.
Location(Street&Number): Az• ,C) t CJ /Z� Unit No�.:7 /�•� 1
Owner or Tenant: C'RA19 M�GKJn E ail: �c.k rsr,Yrinl F/ec}rtc Co»1 /�Itd)"
Owner's Address: qd Ato-t,rj,4 Awl 'Da �i4K,J,d / Phone/Igo.: 92Q�9-r�sa.I
Is this permit in conjunction with a building permit?( eck appropriate box)Yes 0 No NI Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps /_Volts Overhead IIC Underground 0
1i No.of Meters:
Description of Proposed Electrical Installation: p2 p u i r I -s/ A—G 0,—fits
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 0 No.of Devices:
Swimming Pool:In-Grad.0 Above-Grad.0 Hot-Tub Cl 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 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❑ Level 1 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electric Work: (When required by municipal policy)
Date Work to Start: (, r�/,4 / / Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: T C�r.4} A-I❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.: AA K_t1/j
Journeyman Licensee: LIC.No.: E a S 91 q
Security System Business repuires a Division of Occupational'Licensure"S"LIC. S-LIC.No.:y
Address: �//0�2(.e, +Ar.U'V7 ix_ J VAzinoLim 44/7 6/�o� i .,�^Email:LLCk f-c(�L'tt�/J & eC/ jt e ,tvAsi 1 7L Telephone No.: y/h-q-< c2
I certify,under the p les' perjury,that the-�r��on this app on is true and complete.
' Licensee: Print Name: Kr-, Cell.No.:
INSURANCE CO ,', nless aived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of'.,. ding"co pteted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and r proof of a to the permit issuing office.
CHECK ONE: IN URANCE BOND 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.: