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Commonwealth of Massachusetts
Town of Yarmouth
ELECTRICAL PERMIT
Job Address: 14 CUTTER LN Unit:
Owner Name: MINGOS RACHEL L
Owner's Address: 6C SEVEN SPRINGS LN Phone:
Purpose of
Building Residential 14
Is this permit in conjunction with a building permit? No IVI
Existing Service Amps / Volts Overhead ❑ , 'Underground ❑ ,
New Service Amps / Volts Overhead ❑', Underground ❑
Description of Proposed Electrical Installation: septic .
Email:
Utility
Permit
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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: jTotal 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 Modules: Roof -Mount ❑ Ground -Mount ❑
No. of Electric Vehicle Supply Equipment:
Level 1 ❑ Level 2 ❑ Level 3 ❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: September 29, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JEFFREY T FOSS License Number: 36938
Security System Business requires a Division of Occupational Licensure
LIC• License Number:
Address: W YARMOUTH, MA, 026733543 W YARMOUTH MA 026733543 Fee Paid: $50.00
Email:jfoss@yarmouthfire.com Business Telephone: 508-776-4698
INSllRANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the
Ilcensee,,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.
INStJi2gNCE:
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Official Use Only
Permit No.
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W BOARD OF FIRE PREVENTION REGULATIONS Occupancy and h Checked
Rev, 1/t?7) leave blank
APPLICATION FOR PERMIT TO PERFORM ELECT ICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Coda (MEC), 7 CMR I To
(PLEASE PRINT IN INK OR TYPE ALL INFORMATIDM Date: !` r
City or Town of: YAOUTH To the Inspector of Wines;
By this application the undersigned give--notice--of his or herintention to perforinthe electrical work described below.
Location (Street &Number) �' � -AN) JAJ 1
Owner or Tenant 1✓d� Telephone No.
Ownnr1a Addy- --
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service 2?J Amps 1 ,,� _11 Volts
New Service Amps / VoIts
Number of Feeders and Ampacity
Yes ❑ No (Check Appropriate Box)
Utility Authorization No.
Overhoado Undgrd ❑ No. of Meters
Overhead ❑ Undgrd ❑ No. of Meters
Attach additional detail rjdesfred, or rts required by the Inspector of xyir•es,
Estimated Value of 196tric Work: "' _.. (then required by municipal palicy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CO RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unit: s
the licensee provides proof of liabil'ty insurance including "completed operation' coverage or its substantial equivalent. 1-he
undersigned certifies that such co
v rage is in force, and has exhibited proof of same to the ermit issuing ofcc,
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)r
I cerft under the pains and penalties ofperjury, that Are Information our this application is true and eontlrlete.
FIRM NAME:
Licensee: L (�� L IC. NO.:
Signature ,IC. NO.:�<J
,. (lfappflcable ex mpr'1'n�th 1'censenu line) , ,. � Bus .Tel No,• �-
Address: / Alt. Tel. No.: )
*Per M.G*.L. c. 147, s. 57-b1, security work requires Department of rub c Safety "5" Liccirae: TelLicNo.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature bel I h
ow, onek•. en;by waive this requirement. I am the (check �narlAeya.a ( ) ❑ owner F1 owner's nnnni
Telephone No.
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