HomeMy WebLinkAboutBLDE-24-579 4/9/24,7:07 AM about:blank
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c O1t Commonwealth of Massachusetts ov • YA
*UTown of Yarmouth c'
ELECTRICAL PERMIT -` $'
Job Address: 175 STATION AVE Unit:
Owner Name: BROWN RICHARD A(LIFE EST)
Owner's Address: 40 BUCKWOOD DR Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-579
Existing Service Amps I Volts Overhead❑ Underground 0 No. of Meters:
New Service Amps/Volts Overhead 0 Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Replacement distribution panel and cable to the meter.
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.0 Above-Grnd.0 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: $2,200 Work to Start: April 5, 2024
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: MATTHEW GORDON License Number: 55830
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: Dennis, MA, 02638 Dennis MA 02638 Fee Paid: $50.00
Email: MATT.G.GORDON@GMAIL.COM Business Telephone: 508-680-6077
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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j RECEIVED
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Official Use�Onl�
rev_ 2024 C mmonwea/th of Massachusetts Permit No.: 7 f'!t//y
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-E= 1,7-- Department of Fire Services Occupancy and Fee dhecked.
BUI'ti _rki_ :•RTNIEN
By _E -:t[= BOARu OF FIRE PREVENTION REGULATIONS [Rev. I/2023]
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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: 41lS/2'
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): / 7 5r17 • vk H✓e Unit No.: /�
Owner or Tenant: L,c� vtr c Email: /0 U r et. rA , ,00►n Z I e 7, 1_` _,)md,(tam
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ NoJPermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service:_ % 0 15 Amps / Volts Overhead❑ Underground❑ No. of Meters:
New Service: / p b Amps / Volts Overhead❑ Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: t' ' )Vt /fO\Yt e II Ck cn c�-� t\ A. C`/t,tiv,
.Se r v i cr e. vv i (e- -y-'?s -t l., e_ w\ e-r-e( . J
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 0 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 El 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 0 Ground-Mount❑ Level 1 ❑ Level 2 0 Level 3 ❑ Rating:
OTHER:
ri 0-re. 6(41 f-, 1„,cok()\ •1 $ o eri
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: -7,"2-O 0 .J 0 (When required by mun' ' o icy
Date Work to Start: 9 /3/-1,L-1 Inspections to{be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: "Vi eLtj 6 Clp cell 4I-A A-1 ❑ or C-1 ❑ LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 1/1"1 c'l l e vV 66 C cLJ dV, LIC.No.: 5 5 e 3o -g
Security System Business requires a Divi ion of Occupational Licensure"S"LIC. f� S-LIC.No.:
Address: 6-0 C vt.S i A v e- ,�c tit—('k Plc ri Vl t-�
Email: vt-ta ta,G. GorJoV\ Out i ,- C oAl Telephone No.: 5bg' 6-eo 'o77
I certify,under the pains and penalties of perjury, that the information on this application is true and complete. ��
Licensee:� � Print Name: / - f' Ca(7uC'4av�. Cell.No.: - - cebc ,� 7
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 ❑ 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.:
Ma►.
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