HomeMy WebLinkAboutBLDE-23-19492 permit expired 10/29/24`9 AM about:blank
Commonwealth of Massachusetts
Town of Yarmouth
ELECTRICAL PERMIT
Job Address: 36 CAMP ST Unit:
Owner Name: STOCKER-VUJOSEVIC SONYA OKORO BRANDON CHIMA
Owner's Address: 36 CAMP ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19492
Existing Service Amps / Volts Overhead ❑ Underground ❑ No. of Meters:
New Service Amps / Volts Overhead ❑ Underground ❑ No. of'Meters:
Description of Proposed Electrical Installation: wiring & box in basement 4f
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 Modules: Roof -Mount ❑ Ground -Mount ❑
No. of Electric Vehicle Supply Equipment:
Level t ❑ Level 2 ❑ Level 3 ❑ Rating:
Estimated Value of Electrical Work: $ 1,000 Work to Start: September 14, 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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ECE�VP- D
CEP 13 296 nc nWealth of Massachusetts Official Use my
Permit No.: C—_ l Zi
{NG DEPARTM ,p rtment of Fire Services Occupancy and Fee Checked:
E PREVENTION REGULATIONS [Rev. 1/2023]
�sy A► IPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All woj-k to be performed_.in_aceordance.with the Massachusetts Electrical Code_(MEC), 527 C R 12.00
City or'I'own of: YAWOUTH ' il)ate: -
To thefnspector of Wires: By this application, the undersigned gives notices of his or her intention to perform the electrical work described below.
Location (Street & Number): �' )72 e
U&t Unit No.:
Owner or Tenant: g ut?Lo Email:
Owner's Address: � -
Phone No.: c
Is this permit in conjunction with a building permit? (Check appropriate box) Yes ❑ No ['Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead Underground ❑ g ❑ No. of Meters:
New Service: i
Amps / Volts Overhead
❑ Underground ElNo. of Meters:
Description of Proposed Electrical Installation: IAl t (_► V7_Q it ,an A P PV - V i, �,,.
Completi011 of the following table may be waived by the
No. of Receptable Outlets: N). of Switches:.
No. Luminaires: No. of Recessed Luminaires:
No. Appliances: KW: No. Water Heaters: KW:
_Space Heating KW: Heating Equipment KW:
No. Heat Pump's: Total KW: Total Tons:
Sivimmirig Pool: In-Grnd. ❑ Above- 3md, ❑ Hot -Tub [
No. Oil Burners: No. Gas Burners:
No. Air Conditioners: Total Tons;
No. Energy'Storage Systems: KWH Storage Rating:
Solar PV KW DC Rating: Solar PV KW AC Rating:
No. of Modules: Roof -Mount ❑ Ground -Mount ❑
OTHER:
�r of Wires.
Generator KW Rating:
Type:
No. Wind Generators:
Wind KW Rating:
No. Transformers:
Total KVA:
No: Motors: Total HP: Total KW:
Fire Alarm System ❑
No, of Devices:
No. of Self -Contained Detection/Alerting-De
Video System ❑
No. of Devices:
Telecom System ❑
—No-of Outlets.
Security System ❑
No. of Devices:
No. of Electric Vehicle Supply Equipment:
Level 1 ❑ Level 2 ❑
Level 3 ❑ Rating
Atlach additional detail if desired, or a required by the Inspector of Wires
Estimated Value of Electrical ork: I 0
Date Work to Start: _ (When required by muniCipal policy)
dL Inspections to be requested in accordance with MEC Rule 10. aild upon completion.
FIRM NAME:
Master/Systems Licensee:
Journeyman Licensee;
Security System Business requires a Division of Occupational Licensure "S" LTC.
Address:
A-1 ❑ or C-1 ❑ LIC. No.:
LIC. No.:
LIC. No.:
S-LIC. No.:
Email:
Telephone No.: _
I certify, under 1 re at s penalties of perjury, t/tat the ittforiunt/o►r oil this application is true and complete.
Licensee: Print Name:
INSURANCE CO Cell. No.:
E: Unless waived by the owner, no permit for the performance of electrical worts 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.: