HomeMy WebLinkAboutblde-23-19251 permit expired 10/29/247/28/23, 6:35 AM about:blank
. Commonwealth of Massachusetts
Town of Yarmouth
ELECTRICAL PERMIT
Job Address:
18 CAPT BESSE RD
Unit:
Owner Name:
LEIDENFROST KERIANNE E
Owner's Address:
18 CAPT BESSE RD
Phone:
Purpose of
Building
Residential
Is this permit in conjunction with a building permit?
No
Existing Service
Amps / Volts
Overhead ❑
New Service
Amps / Volts
Overhead ❑
Description of Proposed Electrical Installation: Install
3 receptacles
Email:
Utility Authorization No.:
Permit Nu fALDE-23-19251
Underground ❑ No. o r
Underground ❑ `�r� No. o M
/r1 r
No. of Receptacle Outlets: 3
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 1 ❑ Level 2 ❑ Level 3 ❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: July 28, 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: $50.00
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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Commonwealth of Massachusetts Official Use O ly
N!A-- Permit No.: _ ��
- Department of Fire Services Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] -
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed_ in aceordance.with the Massachusetts Electrical Code (MEC), 527 CMR 2.00
City or Town of: YARMOUTH ' Date 7 a
To the Inspector of Wires: By this application, the undersigned gives notices of hi r her intention to perform die electrical work described below.
Location (Street & Nu ber): % �,k p �- i3_ P� 12. C� Unit No.:
nC
Owner or Tenant: a-r?t C1 7ESEmail: I'Dabzle �Q, J b/
Owner's Address: Phone No.:
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 ❑ No, of Meters:
New Service: Amps / Volts Overhead ❑ Undcrground No74�7. of Meters:
Description of Proposed Electrical Installation: -3 -P I �C. �(
Completion of the following table may be waived by the
No. ofReceptable Outlets: No. of Switches:
No. Luminaires: No. of Recessed Luminaires:
No. Appliances: KW: No. Water Heaters: KW:
Space Heating KW: Heating Equipment KW:
No. Heat Pumps. Total KW: Total Tons:
Pool: In-Grnd,
No. Oil Burners:
No. Air Conditioners:
Above-Grnd. ❑ Hot -Tub
No. Gas Burners:
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:
Date Work to Start:
FIRM NAME:
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 Devices:
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
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
(When required by municipal policy)
Inspections to be requested in accordance with MEC Rule 10, and upon completion.
Master/Systems Licensee:
Journeyman Licensee:
Security System Business requires a Division of Occupational Lieensure "S" LIC.
Address:
Email:
A -I ❑ or C-I ❑ LIC. No.:
LIC. No.:
LIC. No.:
S-LIC. No.:
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 office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ Specify:
P fy:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By a signature below, I he eby wave this requirement. I am the: (Check one Owner ❑ Owner's agent ❑
Owner /Age t: GLtrLI_Je
E� Tel. No.:
Signature: 6`� Email.:
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