HomeMy WebLinkAboutBLDE--24-1117 Commonwealth of Massachusetts Official Use Onl
Permit No.:
Department of Fire Services Occupancy and Fee Checked:
Ij 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),527 CMR 12.00
City or Town of: YARMOUTH Date:
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): N 1 O Unit No.:
Owner or Tenant: ALMA/ p 1111 Email: Az-i4N1yr97,1 13 er2f I.CON)
Owner's Address:l}WIIC i7r,/2,3 lifer J// I CC 1Q11L9 Phone No.:
Is this permit in conjunction with a uilding permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: w'rim 1j)Y 56Lnf7DIJ7 } SP/L-/e ral�A'I
Fin / IYJS'fiPc 1i l pz.Zie od 8 -bE-.23- 611584i>t-
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable Outlets: I/1- No.of Switches: Generator KW Rating: Type:
No.Luminaires: No.oRecessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: K 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❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Bumers: Video System ❑ No.of Devices:
No.Air-Conditioners: Total Tons: Telecom System❑ 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❑ Ground-Mount 0 Level I 0 Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1 0 or C-I❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.: RECEIVED
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: JUL 19 ZU14
Email: Telephone No.: wt_ i,c',DEPARIMINT I
I certi,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: 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❑ 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 sign e bellow,I hereby waive this requirement.I am the:(Check oil)Ow r Owner's a ent❑
Owner/Agent (* l\r V Tel.No.: -1g_t— h''_ —
Signature: , Email.: 121/,41 (13l`"Ct ar 1. its
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