HomeMy WebLinkAboutBLDE-26-533 Commonwealth of Massachusetts oltictal}se Only/53
_Permit No.:
AF.-r Department of Fire Services Occupancy and Fee Checked:
lass ,
BOARD OF FIRE PREVENTION REGULATIONS [Rev.12023]
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:4/1S/2026
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):22 Deerfield Rd Unit No.:
Owner or Tenant:John Turnbull Email:
Owner's Address: Phone No.:
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:100 Amps 120 /240 Volts Overhead• Underground 0 No.of Meters:1
New Service: 100 Amps 120 /240 Volts Overhead 0 Underground 0 No.of Meters:1
Description of Proposed Electrical Installation: Repairing Damaged service
Completion of the following table may be waived by the Inspector of Wires. r�
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type: RECEIVED
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: APR 1 1 2026
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: OUILDINr=nc PARTMENT
Swimming Pool:In-Gmd.0 Above-Gmd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alening Devices: By- _._.
No.Oil Burners: No.Gas Burners: Video System Q No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 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 I❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:$3000 (When required by municipal policy)
Date Work to Start:4/18/2026 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-I 0 or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee:Timothy Letoumeau LIC.No.:58079 B
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 12 Renas Way Dennis,Ma 02638
Email:timletourneauelectric@gmail.com Telephone No.:413-834-0434
I certify,under the pains and p ' of pedury,that the information on this application is true and complete.
Licensee' -: ----Print Name:Timothy Letoumeau Cell.No.:413-834-0434
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 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 0 Owner's agent 0
Owner/Agent: Tel.No.:
Email.:
Signature: