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Commonwealth of Massachusetts Permit No.: l 770
i.s Department of Fire Services Occupancy and Fee Checked:
�.='jj^ * 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),52 C R 12.00
City or Town of: YARMOUTH Date: 1 l3 aq
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): In 1 (-�C 1`..-1 Unit No.:
Owner or Tenant: O yvt A Email:
Owner's Address: C-00A,00-4. O one No.:
Is this permit in conjunction with a building permit?(Check appropriate x)Ye No❑Permit No.1j 4 `- ' f5
Purpose of Building: Pr 9'Q I lr(ON P 12.1 j 1 1...0 Utility Authorization No.:
Existing Service: 1 r,0 Amps f,}D/4cfCtrolts Overhead 1;ir Underground❑ No.of Meters: t
New Service: Amps / nn Volts Overhead ElUnderground ElNo.of Meters:
. Description of Proposed Electrical Installation: 9.0t.. .(i A IN 1 iQ> ' 4XL O tTt C.L3T S/17 7 S
GA. - Dizi '.Ilv 6Q DP('Pi ovu Re13ui(--4)(5 21xDtr^-
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable 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-Grad.❑ Above-Grad.❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System❑ No. •
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply uiRle n:CE.- INISD
No.of Modules: Roof Mount❑ Ground-Mount❑ Level 1❑ Level 2❑ Level 3 ng•'-".
OTHER: SEP o 3 2024
Attach additional detail if desired,or as required by the Inspector of Wires. BUILDING DEPARTMENT
Estimated Value of Elea, cal Work: 5C.t.C' (When required at
Date Work to Start: t 3 ?N Inspections�� to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: (2 `. (4,Ikp.G.W p^, Q? C)i yam A-I 0 or C-I 0 LIC.No.:J'3cc?(—El_
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: t2 Q y on Ot- )tp..j )Obtn( 4Q-Di LIC.No.: -3 CO?-t
Security System Businessin requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: /
Address: f 0 `,D( ���1-'t3 ‘'hJ15 `\;-E (\`� Q�(6" f y /,
Email: r w\6C 1 )e..r- ko-, Cs�e-j IMet t '•c0/'Telephone No.: RC&c3" /`(qC)-�.2
1 certlfy,u�j d Tel, r' ,I 1 ormation on this apple lion its true and complete.• y� p
Licensee:Ilii Re Print Name: C�.4-onOF-) > J lv"t.�rE NL j . tG{gr�-V
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 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 signature below,I hereby waive this requirement.I am the:(Check one)Owner❑ Owner's agent 0
Owner/Agent: Tel.No.:
Signature: ll Email.:
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