HomeMy WebLinkAboutBLDE-24-1594 Commonwealth of Massachusetts tteial use J� ,4
Permit No.:t--"2J f�C>`j
I-r, ` �/ Department of Fire Services Occupancy and Fee Checked:
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I;- " 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 MR yz 00
City or Town of: YARMOUTH Date: /0/ tO g l�
To the Inspector of Wires:By this,a plication,the urnde ig givr1s no"t]i�s of his or her intention to perform the electric work d scribed below.
Location(Street&Number): it Qrlj /t2 14 1 Unit No.:
Owner or Tenant: T p i 1-e g Mor,I5 Email:
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes No 0 Permit No.:
Purpose of Building: Util Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts dQ'Overhead❑ Underground_ ti 0 No.of Meters:
Des iptionooffPro osed Electrical Installation: II"it e � p,itg. iT wi oy-1?.
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 0 No.of Devices:
Swimming Pool:In-Gmd.0 Above-Gmd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.AirConditioners: Total Tons: Telecom System 0 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 0 Ground-Mount 0 Level 1 0 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: (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: Vti 444 t icy LIC.No.: Syr �
Security System Business requires a Division of Ocbb/upational Licensure"S"LIC. S-LIC.No.:
Address: 2- id t'i le .lam ,7 4i� /10(4'
Email: '/ 4 Telephone No.: 7 7(�= yp le
I certify,and t pains an p Ides o erjury,that the rmation on this applicati n is true and corn lete. Q
Licensee: Print Name: /4/„.ge:i Cell.No.:11'!� ly?V
INSURANCE COVE .U ess waived by the owner,no permit for the pe orm ce of e ctrical 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❑ 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 0 Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.: