HomeMy WebLinkAboutBLDE-24-1595 10/15/24,4:03 PM about:blank
Commonwealth of Massachusetts -o YAK
Town of Yarmouth `� °
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ELECTRICAL PERMIT �` ` �
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Job Address: 1175 ROUTE 28 Unit:
Owner Name: TOWN OF YARMOUTH
Owner's Address: 1146 ROUTE 28 Phone: Email:
Purpose of
Building Commercial Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-1595
Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Temporary service(s)for the Seaside Festival event.
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❑ Rating:
Estimated Value of Electrical Work: $ 0 Work to Start: October 4, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JESSE J MACKENZIE License Number: 13111
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: S YARMOUTH, MA, 026644156 S YARMOUTH MA 026644156 Fee Paid: $0.00
Email: mackenzieelectric@gmail.com Business Telephone: 1111111111
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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'ommonwealth of Massachusetts Official Use onl
Permit No.: �i — />Jr
LI -Yi, ;t',i Department of Fire Services Occupancy and Fee Checked:
jl BOARp OF FIRE PREVENTION REGULATIONS [Rev.I/20231
''' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date: /O-//- 6.22/
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): RI ,�— Unit No.:
Owner or Tenant: `,//4/e/✓/c jr i-i- < iic i�2 �sL'marT: I
Owner's Address: //S6 ai8 Phone No.:
Is this permit in conjunction with a buildin,P permit?(Check appropriate box)Yes❑ No❑Permit No.:
��Purpose of Building:/tT I7,3 I Utility Authorization No.:
C9[ jExisting Service: coo Amps /,16//76/C Volts Overhead❑ Underground[g' No.of Meters: a
New Service: Amps F---'o'olts Overhead Q-Undergrounds No.of Meters:
Description of Proposed Electrical Installation: /e".11e, r4-e,�?t 7-a/2.... ? It t/A)
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-Gmd.0 Above-Gmd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Bumers: 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 I 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Startup—it-a7L/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 3PS`SG /4>9I I{�(—/t/t-l( LIC.No.: /3j// j
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: '---
Email: Telephone No.:
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 offsce
CHECK ONE: INSURANCE ElBOND ElOTHER 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: S' i a T t/i//9) Tel.No.:
Signature: * j Email.:
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