HomeMy WebLinkAboutBLDE-24-1525- Commonwealth of Massachusetts Official Use O91
Permit No.:
Department of Fire Services Occupancy and Fee Checked:
=m.-;�N N. a" 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),527 CMR 12.00
City or Town of: YARMOUTH Date: !Of► l a q
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): oZ`I 1 U'FFol I( N e.. Unit No.:
Owner or Tenant: P.Ok ffljr Wdc The ids h Ward 'RtyO& RITIalEmail:
Owner's Address: 20 Imd,�n Ave 'fl'lanotne-t mA po►Sits Phone No.: 1p 17.673—6 3 a0
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No Permit No.:
Purpose of Building: Cii,✓I t d 1 Utility Authorization No.:
Existing Service: f Od Amps )026 /alio Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps- / Volts Overhead 0 Underground❑ No.of Meters: 1/
Description of Proposed Electrical Installation: t)C Chi C Rd1'121 'epiaLerival . (pgrdue FYIS�'inQ out,.
6iF1
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 —
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Tota K • E C E I V r: fl
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devic • •- —1
Swimming Pool:In-Grnd.❑ Above-Gmd.0 Hot-Tub❑ No.of Self-Contained Detection/Ale •ng evtipr
No.Oil Burners: No.Gas Burners: Video System ❑ No.of evi es: t► 2 1114
No.Air Conditioners: Total Tons: Telecom System 0 No.of utl •----
No.Energy Storage Systems: KWH Storage Rating: Security System El No.of epees Ct V G L NI,r T M 'T
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: - -
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 ❑ Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: I(W (When required by municipal policy)
Date Work to Start: i b f pil Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: C 6S crisp/ E ff'tcidh A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: 1 LIC.No.:
Journeyman Licensee: elm'I S CYisp1(' LIC.No.: S a-]U6 V
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 18 Troetor Wd2 ! ittplor)'12 1MAr Ca3(Dc
Email: CYt$4trIL1eG K,e Qt .co,,, Telephone No.: lp►7 - 0i€712I-76ti3
I certify,under t epains ndpenalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: C yrr y) C r%$?jn Cell.No.: ' ' 17 ' a`{-1 3
INSURANC VE GE: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 s m e to the permit issuing office.
CHECK ONE: INSURANCE O. BOND 0 OTHER 0 Specify: Wt Sky In W epi vi
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.: