HomeMy WebLinkAboutBLDE-25-1343 (Licen eANci ' Kv•e_c\,
Commonwealth of Massachusetts ofsct use Qn , 9
Permit No.: �2 t `-i
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 accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date: 10/02/2025
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): 8 Jannor Way Unit No.: N/A
Owner or Tenant: Christopher May Email: N/A
Owner's Address: 3546 79TH ST UNIT 51JACKSON HEIGHTS,NY 11372 Phone No.: (508) 737-8747
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑■ Permit No.:
Purpose of Building: Residential Utility Authorization No.:
Existing Service: Amps / Volts Overhead El Underground El No.of Meters:
New Service: 100 Amps / Volts Overhead U Underground❑ No.of Meters:
Description of Proposed Electrical Installation: Temp Service Tapped Of The Neighbors Service
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-Grad.❑ 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 El 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: 2000 (When required by municipal policy)
Date Work to Start: 10/02/2025 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: The Hilb Group Of New England A-1 ❑or C-1 ❑LIC.No.: 8082 Al
Master/Systems Licensee: Jon More LIC.No.: 22967 A
Journeyman Licensee: LIC.No.:
Security System Busine requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 22 Whites Path South Yarmouth
Email: Maya@coastlaphc.com Telephone No.: (508)737-8747
I certify, under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: Jon Moreau Cell.No.: (508)326-9699
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 El 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.: