HomeMy WebLinkAboutBLDE-24-1371 Commonwealth of Massachusetts Official Use Onl
Permit No.: (ph. 111
�j
.114- Department of Fire Services Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023j
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: 7j3/2
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): 4.5"6-$jf /ff9//t/ ,ST("er Z' Unit No.: 9
Owner or Tenant: ,//V,f//// Email:
Owner's Address: dj/!Gr S/ do/i n,vr A'/'O2 y, ' Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes Ej No 0 Permit No.:
Purpose of Building: Ce Utility Authorization No.:
Existing Service: 30 Amps /2 40 Volts Overhead[]'Underground 0 No.of Meters:
New Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
Description of Proposed Electrical Installation: /2c c /.e 6iST//e6ra r
RECEIVED
Completion of the following table may be waived by the Inspector of Wires. --- - -
No.of Acceptable Outlets: 35— No.of Switches: 1 Generator KW Rating: ype sEp f 3 2024
No.Luminaires: 3 No.of Recessed Luminaires: No.Wind Generators: Wind KW'ating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KV.c:.. _
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Tota I�Vk1I-D;NG DE-PARI MEN
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devic ------ —
Swimming Pool:In-Gmd.❑ 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 Electrical Work: se ,yv ,,-, (When required by municipal policy)
Date Work to Start: 9/Z 3 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: O'92/ E c ,y Ly X A-I❑or C-1❑LIC.No.:
Master/Systems Licensee: .22h/1//<-"I_ /% GA}( LIC.No.: /%30
Journeyman Licensee: Z9.4.1//EG // L/)( LIC.No.: Z'/5-g j sf
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email: Telephone No.:
I certify,under the palnd penalties of perjury,that the information on this application is true and complete
Licensee: .t !,tee Print Name: / /,//z-. // G,3X Cell.No.:l//'_s e
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 o'sanie to the permit issuing office.
CHECK ONE: INSURANCE ' BOND 0 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.: 414110,67 543 y fir k eft, I hti',/'%a.