HomeMy WebLinkAboutBLDE-24-1277 RECEIVED
ommonwealth of Massachusetts Offici`al�UseOnly
1 _.��O�t, Permit No.:6%_c--c— tJ�7
1%' 24 Department of Fire Services Occupancy and Fee Checked:
p OF FIRE PREVENTION REGULATIONS [Rev.I/2023]
BUILy 1 'ifigm
°Y '= APP ICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 1 02
City or Town of: YARMOUTH Date: //`fl
To the Inspector of Wires:By thiiss�application,n the undersigned gives notices his or her intention to perform the electrical work described below.
Location(Street&Number):/! CO!U U S ALA- Unit No.:
Owner or Tenant: �f Gcs(,1`lf tC�,(G/t c,.c/J Email:
Owner's Address: c <=.' one No.:
Is this permit in conjunctst�''w�'ith a l uildingpermit?(Check appropriate box)Yes 041o1 0 Permit No.:
Purpose of Building: j4./1>i//Cj/�/t/('///1/ Utility Authorization No.:
Existing Service:2 4/6/7/20 Amps20,14.1a Volts Overhead E'Underground❑ No.of Meters: J
New Service: Amps / Volts 7Oyerhead❑ Underground❑ / No.of Meters:
p!Description of Proposed Electrical Installation: /a a, /4/ 4 '6U/ife �"C) r0 A9060 ele
S e/n°ye 0/1 /Pe -aee1`3t .S'.9.,u) ..0 fo4?
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❑ No.of Devices:
Swimming Pool:In-Gmd.0 Above-Gmd.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 Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level I 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: :(..(7U 4eici (When required by municipal policy)
Date Work to Start:nSi/4'/ou'r C/ Inspeciions to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: (l,47P/ja°q (Ch K 40.f A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: .�4 ryy P LIC.No.: 5—:2A:Z
Security System Business requires a Division of Occupational/Licensuurr�e"S"LIC.•/ S-LIC./No.: /'
Address: // �<1 C4 rN sZl Y{�2'�f-'C /0°11 -a/l50 '( 11/ G ��� �
Email: yPf/UP C1/Ly3Q 3��(r,y:t,&6,-LO/77 TelephoneNo.: 4 c� O 6 -f: '
I certify,under t ails and penalties of perjury,that the information on this application is true and complete.
Licensee: L ��' Print Name:,5745, f1 (-6 4L),,f Cell.No.:_Cl-C a�8 ) 7d/G
INSURANCE OVERAGE: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 sam to the permit issuing office.
CHECK ONE: INSURANCE0--"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 0
Owner/Agent: Tel.No.:
Signature: Email.:
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