HomeMy WebLinkAboutBLDE-24-1385 9/5/24,2:39 PM about:blank
` � c). 1 Commonwealth of Massachusetts I YA.-..
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*; Town of Yarmouth �� ' 1 °;
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ELECTRICAL PERMIT HCORPORR 10\
Job Address: 1100 GREAT ISLAND RD Unit:
Owner Name: Great Island Home Owners Association
Owner's Address: 1100 GREAT ISLAND RD Phone: Email:
Purpose of
Building Commercial Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-1385
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Wiring of storage building next to guard house at entrance.
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.El 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❑ Level 1 ❑ Level 2❑ Level 3 Cl Rating:
Estimated Value of Electrical Work: $ 800 Work to Start: September 5, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: RAY W BOMBARDIER License Number: 33621
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Mashpee, Massachusetts, 02649 Mashpee Massachusetts 02649 Fee Paid: $80.00
Email: rebombardier3@gmail.com Business Telephone: 508-274-9282
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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Cammonwe4an.4 Maadachadelie Official Use Only
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-C.1c A �7 [� Permit No.
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4 h Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [E>yer (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical C),527 op 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dater 3 -Z
M City or Town of: YARMOUTH To the Inspee or of Wires:
By this application the undersigned gives notice/ ofhis or her intention to perform the electrical work described below.
Location(Street&Number) (}0Q.. litI e.A- -ISUc4-rl0 G)t)ARa 5 i4C1G
• '-I Owner or Tenant Cs.,/2•e�L'v S C,a4-a'/() N t`j(Vt f bt�Jp f�phone No.
Owner's Address (( (2O C,,i2_-A4? S-S L),4-e.j.j) Lt.v N/l,2 E /Ur eiLS //.SC!d
to Is this permit In conjunction with a building permit? Yes ❑ No,LJ (Check Appropriate Bon)
Purpose of Building
sQ Utility Authorization No.
Existing Service 100 Amps / /r}whits Overhead❑ Uodgrd,� No.of Meters /
New Service Amps / Volts Overhead Und rd —t-"
❑ B ❑ No.of Meters
2 Number of Feeders and Ampacity '3 (
L E Location and Nature of Proposed Electrical Work: w(fit r_C 1—e)2 gt,.eQ N e y-7- Tn
C7 00-abS(i\ACK--
o Completion of the following table may be waived by the Inspector of Wires.
t!+ No.of Recessed Luminaires No.of Cell-Susp. No.of Total
jp.(Paddle)Fans Transformers KVA _
�t No.of Luminaire Outlets No.of Hot Tubs Generators KVA
4 No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting '
trod, grnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices
i 1 No.of Ranges No.of Air Cond. Tons) No.of Alerting Devices
No.of Waste Disposers Heat Pump Number.Tons__..._.KW No.of Self-Contained
Totals: ... Detection/Alertiny Devices
No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑��,
Connection
No.of Dryers Heating Appliances KW Security Systems:*
'No.of Water No.of Na.of No.of D tit E tvaie f-`F--
Heaters Data Wiring: 7: ! 3
Signs Ballasts No.of Devic s or Equivalent"- 1
No.Hydromassage Bathtubs No.of Motors Total HP Telecommu Inca ons Wirin
No.of De c s a� 1Y�igtt2024
OTHER:
i
n Attach additional detail if desired,or as reaultAbYthritapadtdrAbf4314fNT
Estimated Value of Electrical Work: 3 00'Ov (When required by municipal policy.) By______
Work to Start: 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 0 BOND❑ OTHER❑(Specify:)
I certify,under the pains and penalties of perjury,that the Information on this application is true and complete.
FIRM NAME: RA MD/J C .0PjptnC 1L LICNO.:-83(pa-(---L
Licensee: ' SJ,$.-I).e Signature pit� ,r►r,QiU-.SIC,NO.:
(If applicable.epier"es5grpt'in the license number line.) Bus.Tel.No.: .2'n .1"7(-t 9'd-&a_
Address: t'r' VA_01Z?-tp-r vv.AS fr A- QA}6" "j Alt.Tel.No.:
Per M.G.L.c.147,s.57-61,security work requires D pertinent of Public Safety"S"License: Lic.No.
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)0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. (PERMIT FEE:$
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