HomeMy WebLinkAboutBLDE-24-1282 RECEIVED WICi1/ LIC-I- 64 /
Official Use Only
-- 024 ommonwealth of Massachusetts Permit No.:
,�� �1,, - Department of Fire Services Occupancy and Fee Checked:
Buiu •
a- '?_ ,' AT a 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 C R 1 00
City or Town of: YARMOUTH_ Date: )�� e_/
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical wo described below.
Location(Street&Number): ,80 ("9 ej/}!4J ,Pi,�C 2 Unit No.:
Owner or Tenant: ,-fj/ 7,2,94) (7t/(JL.E-7J'c_ Email:
Owner's Address: one No.: yO 7—2 —7�/9
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 041❑Permit No.:
Purpose of Building: J . A. fir,I/ Utili Authorization No.:
Existing Service: /SD 'Amps /Jo /db/UVolts Overhead 3-Underground 0 No.of Meters: l
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: 4di/'4•c•-r.J rwr,1h S.X -/'A,-✓N J
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: /0 No.of Switches: 'a Generator KW Rating: Type:
No.Luminaires: L/ No.of Recessed Luminaires: ,4/ 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-Grnd.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 1 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 Electric l Work: SODc)•a (When required by municipal policy)
Date Work to Start: Fj�/ z/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1❑or C-I❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: �16/Inl �t i,21C c LIC.No.: E53C 17/
Security System Business requires a Division of Occupatipnal Licensure"S"LIC. S-LIC.No.:
Address: 5"5 0,X L) .iC-X - 6,e 10 0--1/t-.-J /'✓J/-t O/F'D J
Email: A U/'lie /A e ///'9 0,/7'7/I,/ (IUD Telephone No.: 77(/ -] cj —/9,p j
I certify under ains. d p allies of perjury,that the information on this application is true and complete
�License-. + /�
_'.+ 1) Print Name: _11)D//nJ :-- ,�2),---4"- Cell.No.: 7c--/'7r5-5/3,:eq
INSU' NC.COV '7 GE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provi.-s pr.•. of liability including"compl operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in fo- and has exhibited proof of s 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 my signature below,I hereby waive this requirement.I am the:(Check one)Owner 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
OC)
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