HomeMy WebLinkAboutBLDE-24-1526- pi— ,= Commonwealth of=`-_ Massachusetts Official se Only
I' Deportment of Fire Services Permit No.: ( 'N 7
1_=�y4 BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked:
v, . APPLICATION FOR PERMIT TO [Rev. I/2023]
Al!work to be performed in accordance with the Massachusetts ELECTRICAL WORK
City or Town of: Electrical Code(MEC), 527 CMR 12.00
To the Inspector of Wires:B YA R M O U Tel_ //,, _ 2
y this application,the undersigned gives notices of his or her intention to perform the work
described below
Location(Street&Number):
Owner or Tenant: i
Unit No.:�j
Owner's Address: / Email:
Is this permit in conjunction with a building permit? n 3U
one No.: �y_G_ G
Purpose of Building: _ (Check appropriate box)Yes PW Service: � No❑Permit No.:
vG Utility Authorization No.:
Existingx See: Amps It U / K2G Volts Overhead❑ Underground
Amps / Volts Overhead 0� No.of Meters:
Description of Proposed Electrical Installation: ❑ Underground
❑ No.of Meters:
Completion of the following table may
No.of Receptable Outlets: be waived by the Inspector of Wires.
No.of Switches: Generator KW Rating:
No.Luminaires: No.of Recessed Luminaires:
No. Wind Generators: Wind KW Rating:
No.Appliances:
KW: No. Water Heaters:
VA:
Space Heating KW: KW: No.Transformers:
Heating Equipment KW: No.Motors: Total HP: TotalTotal KW:No.Heat Pumps: Total KW:
Swimming oHeat
Pops In-GrnT. Total Tons: Fire Alarm System Devices:
0 Above-Grnd.0 Hot-Tuby 0 No. io No.Oil Burners: 0 No.of Self-Contained Detection/Alerting Devices:
No.Air Conditioners: No.Gas Burners:
Total Tons: Video System 0 No.of Devices:
Telecom System
Solar.PV KWH 0 No.of Outlets:
No.Energy Storage Systems: Storage Rating:
KW DC Rating: Solar PV KW AC Rating Security System ❑ No.of Devic •
No.of Modules: Roof-Mountg: No.of Electric Vehicle Su Iy Eq
OTHER: 0 Ground-Mount 0 Level 1pp ° —
0 Level2 0 Level 3 "Rating- ...
OCT 0
Attach additional detail if desired,or a required by the Inspector of Wires. 2 2024
Estimated Value of Electrical Work: G • � y �_�~-•-__..`__ `---
Date Work to Start; w _ s ��' en required BUILDING DEPARTMENT
Inspections to be requested in accordance with MEC 10,Ririe and upon
FIRM NAME:
�� �, �=— P completion.
Master/Systems Licensee: A-1 0 or C-1
0 LIC. No.:
Journeyman Licensee: LIC. No.: y
Security System Business requires a Division of Occupational Licensure"S"LIC. LIC.No.:
Address: S-LIC.No.:
Email:
r
re t
I certify,and r e pains and Pena er u A..., Telephone No.• _
Licensee: o jp �'�that the information on this application is true and complete.
INS `�`� � Print Name:
COVERAGE; Unless waived by the owner,no permit for the perform ceofelectrical
providesis proof of liability including"completed operation"coverage or its substantial equivalent Cell. No.: ,��y_th �i �;,�
ese ando has exhibited ludingfcme to permit work may issues that unless the ovlicersee
CHECK ONE: INSURANCE the issuing office. •The undersigned certifies such coverage
OWNER'S INSURANCE WAIVER:ND❑ OTHER 0 Specify:am aware that the Licensee does not have the liability insurance
required by law.By my signature below,I hereby waive this requirement.I am the:(Check
Owner/Agent: coverage normally
one)Owner 0 Owner's agent 0
Tel.No
Signature: .•
Email.: