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HomeMy WebLinkAboutBLDE-25-1513 - Commonwealth of Massachusetts Of a'_R ' 6-4.3 Permit No.: Ira . , f Department of Fire Services Occupancy and Fee Checked: =;_t�1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] tAtr 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: 11/10/2025 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): 13 Route 6A Unit No.: Owner or Tenant: Tom Gorman Email: tomsoldhouse©gmail_com Owner's Address: 13 Route 6A,Yarmouth Port,MA 02675 Phone No.: 5084373986 Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No Q Permit No.: Purpose of Building: Single Family Home Utility Authorization No.: Existing Service: Amps 200 /240 Volts Overhead D Underground❑ No.of Meters: 1 New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters: Description of Proposed Electrical Installation: Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: 1 No.of Switches: 0 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: p% Swimming Pool:In-Grnd.0 Above-Gmd.❑ Hot-Tub INNo.of Self-Contained Detection/Alerting DRcE C E 1 V E 1 No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:^No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: NOV 1 0 2025 No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devixs: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipmens: • No.of Modules: Roof-Mount 0 Ground-Mount 0 Level I 0 Level 2 0 Level 3 0 Ra inB,UILDING DEPARTM_l1T OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1000 (When required by municipal policy) Date Work to Start: 12/1/2025 Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: Homeowner-Tom Gorman A-1 0 or C-1 0 LIC.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: LIC.No.: Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: Address: 13 Route 6A Email: tomsoldhouse@gmail.com Telephone No.: 5084373986 I certify, under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: Print Name: Tom Gorman Cell.No.: 8606704222 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 0 BOND 0 OTHER 0 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: Tom Gorman Tel.No.: 5084373986 Signature: Email.: tomsoldhouse@gmail.com