HomeMy WebLinkAboutBLDE-24-1391 SL, Commonwealth of Massachusetts O�iciial Use O l
--=p Permit No.: `- ti l
-liii__: Department of Fire Services Occupancy and Fee Checked: l
e II y BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 MR 12.00
City or Town of: YARMOUTH Date: 1 Cr,/-t'1
To the Inspector of Wires:By this a-p1plication,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&N er): o`Co C A A I..l ,(_)i c.KF/t.50 rJ t OUnit No.:
Owner or Tenant: j ]Zc,A � j\)�2. eq v/_o Email: Fj(`i i627 O. ()Mai L.,,C (11
Owner's Address:.2gS--f-2E J( 57: )"'P 1L 2 GN; b�6(rt P Phone No.: (// -�-/k-'41;131
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ NogPermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: /61rd Amps/DO /J y0 Volts Overheat Underground❑ No.of Meters: I
New Service: AmpQ00 /.14 a.Volts Overhead' Underground❑ No.of Meters: 1
Description of Proposed Electrical Installation: S�g2 V I k,� )1 Gil tiD e
Completion of the following table may be waived 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-Gmd.0 Above-Gmd.❑ 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.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Sup {-- I V F D
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level I El Level 2 El v Aing:`..___.
OTHER:
SEP 06 2)24
Attach additional detail If desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: ?n (When requ ed b itlltlt o1c)✓✓� NT
�� 9 _ r PocY1
Date Work to Start: Inspections to be requested in accordance with ,an upon completion.
FIRM NAME: j '(L i. p rvc C. I/S2 ,OX A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: r p 0 g-i A LIC.No.:
Journeyman Licensee: 3 Ci q f(1 C LIC.No.:
Security System Business requires a Division of Occupational Licensuure"S"LIC. S-LIC.No.:
Address: r2cl.S ZE2 I`-51✓ Sr. -2...,D TLc ii C u)c,N,£.6) r r, 0')0>O
Email: b tll ro 0 9 fnQ+C coN? Telephone No.: `113- .2)'2 j7.,1
I certi under the pains s�and penalties of perjury,that the information on this application is true and complete.
. License�itt "
�nj ^- Print Name: g Q.,LI p G i 2.)U. Cell.No.:Y I-�11'i-rj.)->it
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 0 Specify:
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance coverage normally
required by law.By m signature below,I hereby waive this requirement.I am the:(Check one)Owner 0 Owner's agent❑
Owner/Agent: K rat,nni C I P.c.)lam. Tel.No.: y i 3- l-f-. q y
Signature:` './ - /0 Email.:sb rG'tTO ma,IL r din