HomeMy WebLinkAboutBLDE-24-1593 Commonwealth of Massachusetts o rcial se 7
_ Permit No.:
- 3=1•rl--, Department of Fire Services Occupancy and Fee Checked:
ti- BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023]
-
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC,
City or Town of: YARMOUTH Date:
To the Inspector of Wires:By thi a li Ion, nder�s' `d cs notices of his or her intention to perform the electei wo describe below.
Location(Street&Number): d Unit No.:
Owner or Tenant: INS- kid-in L(..0 Email:
Owner's Address: Phone No.:
Is this permit in conjunc n w b ilding permit?(Check appropriate box)Yes'' No 0 Permit No.:
Purpose of Building: /Q TQf Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
New Service: Amps / Volts Overhead 0 Underground 0 ` No.of Meters:
Description of Proposed Electrical Installati9n:
t 1
04- i tI b?f/ /4fide b!t
Completion of the following table may be waived by h/e 7Inspector of Wires.
No.of Receptable Outlets: No.of Switches: p— 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-Grnd.0 Above-Grad.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 I 0 Level 2❑ Level 13 IR ktati%:r- 1 a' „ P
OTHER: I �"
I i_. 0 9 2024 Attach additional detail if desired,or as required by the Inspector of Wires. GU i)
Estimated Value of Electric W rk: (When require bylmunici a►policy) 1
gU.;D , >upo= G:C�
Date Work to Start: Inspections to be requested in accordance with ME le]0,and upon comp eti n.
FIRM NAME:
A-1❑or C-1❑LIC.No.: _
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: EcksVacal I,74 C LIC.No.: 7 4 p9F
Security System Business requires a Division of Occupational Licensure"S" IC. /S--LIC.No.:
Address: /J2,"r% br cjgeo/ e• ?/4,41,6(7`y /p 3
Email: Y/�(hcati I yi`/ ®l��ilf/L(CF �(wf Telephone No.: 77 F^A99.---giig
I certify,and a pains a d penalties of erjury,that the in or lion oq this applieatl is true and complete./G F�nn (J Q�
Licensee. rint Name: m l )t7 7 Cell.No.: 7/ Oi/27— 3.7�(/INSURANCE COVERA :Unl ss waived by the owner, o permit for the perform ce of electrical work may issue unless the licensee
provides proof of liability including"ompleted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof f e to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 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❑
Owner/Agent: Tel.No.:
Signature: Email.: