HomeMy WebLinkAboutBLDE-24-1306 g . Commonwealth of Massachusetts Official Use Only
- - Permit No.: �7-5-E—(?j 0 C,o
IE `eIgI`_i Department of Fire Services Occupancy and Fee Checked:
�el ' 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) 2 CMR 00
City or Town of: YARMOUTH Date: ?-3
To the Inspector of Wires:By th tipplication,the undersigned gives notices of his or her intention to perform the electrical work desc'bed below.
Location(Street&Number): "J FS C,. 'J`e-1JI'2i-✓ C 2_ Unit No.:
Owner or Tenant: GAS L-' -iv1 co?e2 0 2 I V Email;(' A-ri b lv e k G e-ei.0 iYO4t t CpVv•
Owner's Address: S A .N1 Pli one No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes rid-No 0 Permit No.:
Purpose of Building: PO O Utility Authorization No.:
Existing Service: ('O tf-' Amps I / d if Volts Overhead -Underground 0 No.of Meters: /
New Service: Amps / Volts Overhead❑ Underground 0 No.of Meters:
Description of Proposed Electrical Installation: f i) Tiet-t(r4 Qr1 U N.) O 1-- CO rV D",t r5 COY`JDJC--T012-S
A n t D(a.)1 -1- q M ur. Or1v t=pf2 n f'eJ2- A''r]-r vit1 o7J S w(w.rv,14)7 ,0/
Completion of the following table may be wa'ed 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-Grnd.0 Above-Grad.0 Hot-Tub❑ 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❑ No. D
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Eq 'p C E, I V
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1❑ Level 2❑ Level 3 I erg:
OTHER: AUG 212024
Attach additional detail if desired,or as required by the Inspector of Wires. BU I LDI N G DE PARTM E NT
Estimated Value of Electrical Work: 6dp o (When required
Date Work to Start: J-'5 IInspections to be requested in accordance with MEC Rule l0,and upon�coompletion.
FIR rtn�-al
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M NAME: 1 rye -D} IN gi)PAP)/9.4ZPI" a-- A-1❑orC-1Ill LIC.No.: 7 /-L
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 1`iC/-',/rYI ON./\r) t1/4.)RV Ark.Pj/ .Ov/l LIC.No.:—4-3 ep-2-/--zz
Security System(Alusiness requires� a Division�of Occupational✓Lie sure"S"LIC. ,S1-LIC1.No.:
Address: t D P77 0 O-tii L I.- m+/7�'J -e (iYIrT e,)-(.P�-1 1
Email: r In) b O ry h d (.e i- 3ls',/ma I l- Ct9lielephone No.: 6'(`j 5j )-7`( aloz 5(Z
I mi.*, der the pa andand en les of p rjury,that the�information on this fro*licanon is true and co ,fete
Licensee: t�1]tAU� Q rintName:M[ 11 1.�QJ6`, ' �,�� '1' (JG�'1 t- • o.a. l O'
INSURA_CE VE G :Unless waived by the owner,no petit 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 0 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 0 Owner's agent❑
Owner/Agent:
Tel.No.:
Signature:
Email.: