HomeMy WebLinkAboutBLDE-24-1568 Commonwealth of Massachusetts Official use Only
Permit No.: 02 1f,(.5e.e
_)d!=et Department of Fire Services Occupancy and Fee Checked:
•. i j=�;,' 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 C 12 0
City or Town of: YARMOUTH Date: 1 D 1 /.20,2`F
To the Inspector of Wires:By this appli tion,the undersigned gives notices ofkqis or her intention to perform the electrical work d bed below.
Location(Street&Number):_ / I R.V S SO ,2 Gt.- (n/./k4ti'" Unit No.:
Owner or Tenant: y/CO/t D 141,4SS I cell-- Email:
Owner's Address: 40 Led t, ,r n a vt (.Cie[1 Eon AO 0 0 N za Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No 0 Permit No.:
Purpose of Building: 0 U r k•c od St r✓tvt re(tt cn(s.r.. Utility Authorization No.: t R D a G q 23
Existing Service: 2-0(0 Amps /20/ 2 WVolts Overhead[]Underground❑] No.of Meters:
New Service: 2-0 0 Amps /72/ Z`tOVolts� //Overhead❑ Underground ly /No.of�Meters:
.. Description of Proposed Electrical Installation: Re IOcw*G 2 m e A n.J o.r C.ria.,...1 vte_aa. Sl r-vre.P
0 Pl. Rjv,1/,,, 'l`s 200 H vAderyoord r es c3 ' pt-i ,f- M.c r
Completion of the follow)ing 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 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-Gmd.0 Above-Gmd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air•Conditioners: - Total Tom: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System❑ 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❑ Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electric W rk: (When required by municipal policy)
Date Work to Start:,t�/D�(�V T Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: /V'et f 1 S c 4 o c.e A-1❑or C-1❑L1C.No.: A-13?1
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: "I'T nt I.vt. CA' G✓Gsj'y0Lwtor nl
Email: Pl•G 1
1
C'(-2 Cn @ C0A4c..'-cIi• vILT • Telephone No.: S'd8 776'I I S7
I cent pata and al es of perjury,that the information on this application is true and complete
Licensee: + Print Name: /" .J r1 e c ( tot nc-- Cell.No.: .SUP`"? /IPS 7
INSURANC COVERAGE: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 same to the permit issuing office.CHECK ONE: INSURANCE 0 BOND❑ OTHER 0 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.: