HomeMy WebLinkAboutBLDE-24-1476 Commonwealth of Massachusetts (Ofc�al Use Oply,C l rQ
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Permit No.: e�
k - i Department of Fire Services Occupancy and Fee Checked:
-- inBOARD 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),527 CMR 12.00
City or Town of: YARMOUTH_ Date:Cc-7 z,5 i 2 c,z`I
To the Inspector of Wires:By this application,the undersig d gives notin i f his or her t n to perform the electrical work described below.
Location(Street&Number): Z'1 6 ,� rj* (Jn,t �i Unit No.:
Owner or Tenant: r.` c��
,n c r L� ait.:/
Owner's Address:
2 c(� /•;./h EJr 1c t/ir r f / Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
_ Purpose of Building: •e5 r 4/c A Utility Authorization No.:
Existing Service: 01, V Amps/CO / 2'1('Wolts Overhead❑ Underground No.of Meters: ,•S
New Service: Amps / Volts Overhead❑ Underground E.
No.of Meters:
Description of Proposed Electrical Installation: t /,'-'e. / fG� /c/ii4i, 2c/O t/
\J 0uc-fle5c, .S/)/if Cl2cr�J
Completion of the following table may be waived by the Inspector of Wires.
J 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: 1 Total KW: j.o.,.;;'Total Tons: / Fire Alarm System El No.of Devices:
�V Swimming Pool:In-Gmd.ElAbove-Gmd.El Hot-Tub El No.of Self-Contained Detection/Alerting Devices:
n\ Na.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
VC 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❑ Level 2❑ Level 3 0 Rating:
- OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: '5 7, • "G (When required by municipal policy)
Date Work to Start: / Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: Y„r f- 0...,4,...,7 �Ycf(.c,—1 A-1 0 or C-1❑LIC.No.:
Master/Systems Licetsee: LIC.No.:
Journeyman Licensee: LIC.No.: T'/U9�
Security System Business r es a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /u�c 5 �! Gr 5�r co `7/
Email: C)/irt)c n(i<c f t,' �%e..A l'v,4-1 Telephone No.: )7�. 9'7 C/% /CCf
I certij",under the pains a d penalties of perjury,that the information on this ap atlon is true and complete.
\ censee: Print Name: /iy�•f do.7 Cell.No.: 7Jy 79�y�c�
I\ ' INSURANCE Unless waived by the owner,no pe it 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
(l--) is in force and has exhibited proof of a to the permit issuing office.
c., 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: Email.: