HomeMy WebLinkAboutBLDE-24-1392 Commonwealth of Massachusetts ff"aJ us,Qnl
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Permit No.: 7�1-lil �'
1s V -H7 Department of Fire Services Occupancy and Fee Checked:
=_I=-'' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023]
�'• APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 .0 1I
City or Town of: YARMOUTH_ Date: 04
To the Inspector of Wires:By this applicat n, ed ivy'otices o his o e int ion to perform the electrical wo descri d below.
Location(Street&Number): et., 1W' s Unit No.:
Owner or Tenant: ( 4/ /1/44d4/ �,�/`r�' ail: y
Owner's Address: j' MA Cr 1S i Phone No.: 5(�p-7 ?
Is this permit in conjunction with a building permit?(C ec apriate box)Yes 0 NooPermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Oar Amps /A"/ VU Volts Overhead% Underground 0 No.of Meters: (
New Service: Q b Amps /20/ Volts Overhead, Underground❑ No.of ,eeteer 0rs:
t
Description of Proposed Electrical Installation: ��Cf�° G/e, rt
t/eK r 1,/ f /(sale s
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-Grnd.❑ Above-Gmd.0 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 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❑ Ground-Mount❑ Level I 0 Level 2 0 Level 3 0 AaRs:E C F I V E=
OTHER: i-SAttack additional detail if desired or as required by the I ector of Wires.
SEP-06-2 - °
Estimated Value of Electr' I or (When required by m . �p0q PARTM ENT
Date Work to Start: 7 b Inspections be requested in accordance with MEC Rulq 10,and-ueoncompletion,_
FIRM NAME: Y nc7 A-1 0 or C-1 El LIC.No.: y
Master/Systems Licensee: � LIC.No.:
Journeyman Licensee: 2--e.(fiey TI %if57` LIC.No.:4 369357
Security System Businessrequires
/a Division of/OOcccuupational,L/icen�ssure"SS"LIC./�./� ASS--LLIIC.No.:
Address: // 5 I,eU, A' r '/U I/4I 'QU7/rl/1 Dig?) �q
Email: ( - G Telephone No.: .J(1J77/ fr'1IJI
I certify,under the ai and penalties of perjury,that the infor film this appiicatio true and co lete.
Licensee: i�Yf Print Name: ��V�.K(7 /t (X5Cell.No.:)6 i/Uc 5/9
INSURANC C ERAGE: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 covers
is in force and has exhibited proof of same to the permit issuing office. /� /�
CHECK ONE: INSURANCE(� BOND 0 OTHER 0 Specify: /�eet-� (�t/e !t
OWNER'S INSURANCE W I ER: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 0
Owner/Agent: Tel.No.:
Signature: Email.: