HomeMy WebLinkAboutBLDE-24-822 5/23/24,6:12 AM about:blank
Commonwealth of Massachusetts of:YR ,
* ` Town of Yarmouth
ELECTRICAL PERMIT "
Job Address: 13 ROUTE 6A Unit:
Owner Name: GORMAN THOMAS
Owner's Address: 13 ROUTE 6A Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-822
Existing Service Amps/Volts Overhead ❑ Underground El No. of Meters:
New Service Amps/Volts Overhead ❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Receptacles & lighting.
No.of Receptacle Outlets: 13 No.of Switches: 1 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: ln-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System El 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 El Ground-Mount❑ Level 1 El Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 1 Work to Start: May 13, 2024
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.el Madeackeestte Official Use Only
,`, B '"t cc-� cry Permit No. t—�— 6 Z-2.-
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fi r.4 Occupancy and Foe Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07} (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
v
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (13 )z..0-2--/
City or Town of: L. Lt_iI .&,—t Pa-c+ To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Street&Number) ( (-<),c,L,.. (fr}—
aU
Owner or Tenant c,,‘..c j &tt .v\—c.L/\ Telephone No. (C 4 %i €2 21-
Owner's Address J 3 Vic: LA+ - (c LP(A,,,A,cat-i4 -Xi,:_) v '
e Is this permit in conjunction with a building permit? Yes ❑ No E (Check Appropriate Box)
Purpose:of Building (4,16• k SttU t) Utility Authorization No.
-mod Existing Service 2:x Amps I / Z�tOVolts Overhead T Ur;tigrd Nu.of Meters /
0
New Sie ice Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
tO
Number of Feeders and Ampacity
- Location and Nature of Proposed Electrical Work: P.jti&k — Pc.1,V yI <1‘S—r k
mt
,, ; Completion of the following table'my be waived by the lnpectar of Wires.
No.or Total
No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans Transformers KVA
"
Qt/
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergency Lighting
No.of Luminaires Swimming Pool grnd. ❑ grad. ❑ Battery Units
;,,:„` No.of Receptacle Outlets (-- No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches / No.of Gas Burnerso.of Detection and
Initiating Devices
1, ...i No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW 'No.of Self-Contained
1 Totals: 4Detection/Alerting,Devices
No.of Dishwashers Space/Area Heating KW Local❑ Muni
eettn tiop on 0 Other
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Equivalent
No.of Water KW No.of No.of Data Wiring:
]Heaters_ _ _ Signs :Ballasts .. . _ No.of>Qe cFea or F uivalent
i c tern adon g .. �
No.Hydromassage Bathtubs _ jo.of Motors_ Total HP No.df'6DDces oZqulvai8st
OTHER:
Attach additional detail if desired,or as regal bylhkh or of Wires.
Estimated Value of Electrical Work: _ (When required by municipal policy.)
Work to Start: V/3 /Zc(,) Inspections to be requested in accordance with MEC RuTh t t),;and Upon completion.N 1 i
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance lot electrical.work ntay.issue.unlbss
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.
CHECK ONE: INSURANCE 0 BOND [] OTHER ❑ (Specify.)
I certify,under the pains and penalties of perjury,that the in;vrmat ion on this application is true and complete.
FIRM NAME: LIC.NO.:
Licensee: Signature LIC.NO.;
(If applicable.enter"exempt"in the license number line.) Bus.Tel.No.;
Address: .__ __ Alt.Tel No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No.
OWNER'S INSURANCE WAIVER: I am await: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 1
Signature ,-.._ Telephone No.__ __1 PERMIT FEE: $
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