HomeMy WebLinkAboutBLDE-24-1093 _ - Commonwealth of Massachusetts Wicial use l
Permit No.: ZJ-f—
{ 3
*- t.=ct Department of Fire Services Occupancy and Fee Checked:
0 II=-4' 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),527CMIt 12.00
City or Town of: YARMOUTH Date: rd/ i
To the Inspector of Wires:By this appli9gapn, undc igned ea ces of his or her intention to perform the electrrical rk described below.
Location(Street&N�er): �3—`I��/wobez6-e 4 Unit No.: �!./'
Owner or Tenant: —�7f"/e' —{34(Vt1 t Email:
Owner's Address: aq/ne Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: y t'se S i Wyk, 1-A/t1L Utility Authorization No.:
Existing Service: ''Cb Amps/2d /21/ Volts Overhead 0 Underground 0 No.of Meters:
New Service: Amps /_Volts Overhead❑ Undergroundn/ El No.of Meters:
Description of Proposed Electrical Installation: L,J ///// &.t +,qc gi'Ard/MD--/ SCu//_
5
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable 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-Gmd.❑ Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.AirConditioners: - Total Tons: Telecom System 0 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 0 Level 1❑ Level 2❑ Level 3D Rating.
OTHER: RECLIVED
Attach additional detail if desired,or as required by the Inspector of Wires. JUL 1 6 2024
Estimated Value of Electri9a1 Work (When required by r`nnicipal policy)
Date Work to Start: 7/6/2/ Inspections to be requested in accordance with MEC Rgyl ilfli anrltnpent anon.
FIRM NAME: ° --_ —
A-1 0 or Gl L1�.rvo.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email: Telephone No.:
I certify,untie the pains and p nnallies of perjury,that the information on/this a plication is true and complete.
:, �� ✓ a2.0./1 Print Name: :YetieV /J/u Are--. Cell.No.:
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 m signature b low reby waive this requirement.I am the:(Check one)Owner Er-
Owner/Agent: \ iWi/(. , ?h0->Z� 1 Er-Owner's agent 0
�� �//j Tel.No.: SCE 726 b�l7�-5c*/-6�5-e5'2t{
Signature: j uPirr „.. t'J ch .n Email.: SO/Pan/PO t/0,4 .6Di