HomeMy WebLinkAboutBLDE-23-19085 7/11/23,7:21 AM about:blank
- Commonwealth of Massachusetts of •Y44 .
*Jo Town of Yarmouth , 0
ELECTRICAL PERMIT ,f'
Job Address: 13 WEST GREAT WESTERN RD Unit:
Owner Name: KELLER DANIEL A KELLER KRISTEN M
Owner's Address: 13 WEST GREAT WESTERN RD Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19085
Existing Service Amps/Volts Overhead 0 Underground 0 No,of Meters:
New Service Amps/Volts Overhead 0 Underground 0 •`Norof:MMeters:8
Description of Proposed Electrical Installation: Add 3 lights to farmers porch, new lights & rk ep0clei i9 . 3
No.of Receptacle Outlets: 8 No.of Switches: Generator KW Rating: `.I; fyyed ,'A df
No. Luminaires: No.of Recessed Luminaires: 8 No.Wind Generators: Wind KW RamQ , °, ..'
.
No.Appliances: 2 KW: No.Water Heaters: KW: No.Transformers: Total KV1 .
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: 4
)4)
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool: ln-Grnd.❑ Above-Grnd.❑ 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 0 Level 2 0 Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1,000 Work to Start: July 11, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: License Number:
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Fee Paid: $75.00
Email: 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:
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'� Nj 1 O 2U23 a arinunf o cc-��' Permit No. &/i2?— ,0 t J✓
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' Occupancy and Fee Checked
, „IBOARCketFEINFR PREVENTION REGULATIONS Rev. 1/07]
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v ' ' I. LICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL I FORMATIQYj Date:
.. City or Town of: S.v'¢'k c rvK it.a'!�l To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical wojk described below.
i� Location(Street&Number) 1 3 (,4Je.S+ CPt4 -} ki-es Ile R".r'e
('� Owner or Tenant /4 h it / )e/1 a r- Telephone o cP- 73 "U U 6<
Owner's Address 5t.,rsK,
3 Is this permit in conjunction with a building permit? Yes No ID (Checfi Apprgp' te 'a
f
'L 1 Purpose of Building rise W ev'S a�i.)1 t Do Pikcrd Utility Authorization No. -^:-//eti /
V ( Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of> /
1{' i New Service Amps / Volts Overhead E Undgrd ❑ No.of Meters
V) Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: hlrAd 3 L LI'e1 f tl lye.t f rp,,e bkr A' d T
N ., 0-4-k fl f- i?ect'slid 1-t h tz AA Do r wA,t nl
Completion of the following table may be waived by the Inspector of Wires.
Total
No.of Recessed Luminaires Q No.of Cei.Susp.(Paddle)Fans Transformers
KVAsformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting
grnd. grad Battery Units
No.of Receptacle Outlets e No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
al
No.of Ranges No.of Air Cond. T No.of AlertingDevices
Tons
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained '
Totals: Detection/Alerting_Devices
No.of Dishwashers Space/Area Heating KW Local❑ Monneunicictipalon ❑ other
C
No.of Dryers Heating Appliances KW SecuriNo o Syf Devices or Equivalent
No.of Water , No.of No.of Data Wiring:
Heaters Signs Ballasts
l: No.of Devices or Ffquivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunica ions Wiring
No.of Devices or Equivalent
OTHER:
V <J V J Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of 1 triccal Work: (When required by municipal policy.)
Work to Start: CH AY 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 ❑ 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.:
(If applicable.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 ins ranee coverage normally
required by law. B my si a e low,I hereby waive this requirement. I am the(check one) owner ❑owner's agent.,
Owner/Agent
Signature Telephone No. PERMIT FEE:$
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