HomeMy WebLinkAboutBLDE-23-002004 tertwr
Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-23-002004
�,•�' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
fRev.1/07j
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT/NINK OR TYPE ALL INFORMATION) Date:10/14/2022
City or Town of: YARMOUTH 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) 27 DAVIS RD
Owner or Tenant WORTH KAREN M Telephone No.
Owner's Address 27 DAVIS ROAD,SOUTH YARMOUTH,MA 02664
Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service 10 Amps 14 Volts Overhead 0 Undgrd 0 No.of Meters
New Service Amps Volts Overhead El Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Install 14.0 kW panels.Will not exceed roof panel but will add 6"to height.35
panels total.
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ In- No.of Emergency Lighting
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Gas Burners No.of Detection and
Initiatine Devices
No.of Ranges No.of Air Cond. total No.of Alerting Devices
Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers
Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal p Other:
Connection
No.of Dryers Heating Appliances KW Security Systems:*
No.of Devices or Eauivatent
No.of Water KW No.of No.of Ballasts Data Wiring:
Heaters Signs No.of Devices or Equivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion.
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.
CHECK ONE:INSURANCE 0 BOND 0 OTHER 0 (Specify:)
I cerrify,under the pains and penalties of perjury,that the information on this application is true and complete.
FIRM NAME: TRINITY SOLAR INC
Licensee: Bruce Junior Signature LIC.NO.: CSFA-067961
(If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:
Address:8 Somerville Street,Marshfield MA 02050 Alt.Tel.No.:
°Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License:
OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But my
signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. 'PERMIT FEE:$150.00
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