HomeMy WebLinkAboutBLDE-24-1094 Commonwealth of Massachusetts Offici I Use only,
- Permit No.: ^-1 0 W.1
Department of Fire Services
Uir
Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev.t/2023]
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:Jvi Li I'D i z.z
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):'( fvY'ev f-6 4�, Y4 vti(0,.1--C,P.r-i- Unit No.:(, t v c r-.3 r,/ 1
Owner or Tenant:Ell e r vt 4 . 64'1]14 4 VI Email: 50Y,_ -741 73(3
Owner's Address: .,-(,,,,, � Phone No.: O�-c((�2 7?C(c{
Is this permit in conjunction wiltP a building permit?(Check appropriate box)Yes No El Permit No.:
Purpose of Building:3),, ,,1wri Utility Authorization No.:
Existing Service: Ahips / Volts Overhead❑ Underground 0 No.of Meters:
New Service: Amps /_Volts Overhead 0 Underground❑ No.of Meters:
.. Description of Proposed Electrical Installation:)f q S�Ci/(3�&:�2�lac (i� (i(Tr .t F C�F 0 6E5
/U A-0F 6(:'ua-'1"--- -'.,73,de-1--1.l.Igll -K( u afi- .�/LIC'tf- StnL-Z-(34t-5
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-Grad.0 Above-Grad.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 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 Equip."'.t:—MEC EIVP D
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level I 0 Level 2 0 Level 3 0 Rating--- ---—
OTHER:
—__--- JUL 151024
Attach additional detail if desired,or as required by the Inspector of Wires.
UILDI Gi�EepARTMENT
Estimated Value of Electrical Work: (When required by npllcrpai policy) _
Date Work to Start:7(5 -ZBZcf. Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-I❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee:.)Q.(-f/0 0¢-5� c✓ LIC.No.:3(X 6 t--
Security System Business requires a Division of Occupatiip-nall Licensure"S"LIC. ,/WS-LIC.No.:
Address: 2 7L�r(er/ 5 tJ,, L(Deu (.S ('" -- O 6 -
Email: Telephone No.: VI— 2-'2(-3 5"-4 1
I certify,under the inppenallies of perjury,that the information on this application is true and complete.
Licensee: (�/4i �Print Name:T(5�t,_ lTfk S$7 Cell.No.:-E j—ZZ(—ON,
INSURA CYjVERAGE:Unles aived by the owner,no permit for the performanc of electrical work may issue unless the licensee
provides f of liability including"completed operation"coverage or its substantial equiva ent.The undersigned certifies that such coverage
is in force and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE it/:OND 0 OTHER 0 Specify:
OWNER'S INSURANCE W 0't ER: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 0
Owner/Agent: Tel.No.:
Signature: Email.:
rh assay Cornett/,nef-