HomeMy WebLinkAboutBLDE-23-19309 8/9/23,7:07 AM about:blank
Commonwealth of Massachusetts of YA
a Town of Yarmouth .
ELECTRICAL PERMIT
Job Address: 311 GREAT ISLAND RD Unit:
Owner Name: LIPNICK SCOTT
Owner's Address: 108 CHANDLER ST Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-23-19309
Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
New Service Amps I Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Take over job. (2nd &3rd floor)
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: $ 8,000 Work to Start: August 1, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: JOHN MARA License Number: 58035
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: WEST YARMOUTH, MA, 02673 WEST YARMOUTH MA 02673 Fee Paid: $75.00
Email: mara.john.r@gmail.com Business Telephone: 339-927-7596
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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RECEIVED
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- �J23 ommonwealth of Massachusetts Permit No.: f ficiai _ t`-C 3 cd
_111 _ Department of Fire Services Occupancy and Fee Checked:
BUIL: -`'�'=-y � � OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
By: :4:_:=t i
'`*`="t 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 0 Date: Y
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): S I I 6 Lc T 15 L f 1v 0 !Z 0 Unit No.:
Owner or Tenant: S C b TT 1 I F A,t C e Email:
Owner's Address: 3)) ize--79; / 5 i jt.z 72 p 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: 2 co Amps ae, l ,yVVolts Overhead 2r Underground❑ No.of Meters: /
New Service: Amps / Volts Overhead El Underground❑ No.of Meters:
Description of Proposed Electrical Installation: _2 4'0 Fceo 4 A jfp jjl D/i) ` 7 z Ea(/Ei-
erife at= i )(A. A H 7 /✓2-6 4 I,- r1/0/S# .t jog
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.❑ 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:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ,$-- B (When required by municipal policy)
Date Work to Start: 4 u�, / s r Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 7GN N tul A 2 A EL FC T/E I C A-1 ❑or C-1 ❑ LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: S'8 O 3 $ _ LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /3 /P/NC o o 0 AD W Mee-m a or lf ✓14 O '. 3
Email: /0 /91 . A . J h`N - , , r? 6 It') R j L , Con Telephone No.: 33? - 702 7 ' � S ' 6
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: U v _Print Name: J o "►-1 N M A 2 Cell.No.: 33 9` 5 g - S 9 d
INSURAN COVERAGE: nlaived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"com ted operation"coverage or its substantial equivalent.The unuersigned certifies that such coverage
is in force and has exhibited proof of s e to the permit issuing office.
CHECK ONE: INSURANCE BOND El OTHER El 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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