HomeMy WebLinkAboutBLDE-24-378 3/8/24,6:29AM about:blank
Commonwealth of Massachusetts of YA.+
* d, ; Town of Yarmouth ,, 3
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ELECTRICAL PERMIT �'�
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Job Address: 14 WHALE RD Unit:
Owner Name: WOJNAR THEODORE J JR TR
Owner's Address: 2300 WOLF ST 15A Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-378
Existing Service Amps I Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Communications&AN
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: 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 El Rating:
Estimated Value of Electrical Work: $ 3,000 Work to Start: March 4, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: License Number:
Security System Business requires a Division of Occupational Licensure
"S" LIC. C License Number:
Address: �" Fee Paid: $45.00
Email: t y I ~ 5 P'�-
Business Telephone:
Gin,sL-Iran u� t 2-1.3 2-,
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: 96,Q : 0 5 vi' v4 Ft 4 cm A-n-real&
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Commonwealth of Massachusetts Official my
I t Permit No.: /
�- Department of Fire Services Occupancy and Fee Checked:
(.=` 1=— BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
'4.•-.4' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 C R 1 .00
City or Town of: YARMOUTH _ Date: -( 5/j '
To the Inspector of Wires: By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 4it WM,t� (0{ 0 Unit No.:
Owner or Tenant: WO C Nt'1.1._ "I' u&De,2..� TP- Email:
Owner's Address: -J 2-zy0 W jug ST iS'A "ti4t , '�• .. Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box) Yes❑ No❑ Permit No.:
Purpose of Building: .21_, p 51")ttAu. Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: LOWQe�.A,Gt_ (j)% (\t 06 I-0/L 6cpl GtOcACX
(3tDJ71) &o w)bi 1
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❑ No.of Devices:
Swimming Pool: In-Grnd. 0 Above-Gmd. 0 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 0 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 0 Level 3 0 Rating:
OTHER:
WC. -(4-? ►-1(Cnt1,41) 0 014-E Wit- I /u 2S 4 *Ili
Attach additional detail if desired, or as re aired by the Inspector of Wires.
Estimated Value of Electric 1 Work: m (When required by municipal policy)
Date Work to Start: �tf/2 3 am Ins ections to be requested in accordance with MEC Rule 10,and upon completion.
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FIRM NAME: 4i� Co r ISostryi,vtc e, v.r(Pi 41,4 Sonio rant) A-1 ❑ or C-1 ❑ LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: ?4 c 65/14. 7nr"2 -i ov rrt r ,Nl7/
Email: Oct ,tt-mot-Li: WI iCi 4/4 Si►Y)4f-/t f t Gam«; Cam _ Telephone No.: S g 3‘y - / /9
I certify, under the pains and penalties of perjury, that the information on this application is true and complete.
Licensee: Print Name: Cell. No.:
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability 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 ❑ OTHER❑ 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❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature:
Email.:
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