HomeMy WebLinkAboutBLDE-24-1724 7�, OO
Commonwealth of Massachusetts Official Use Only
_-__ , Permit No.: ChrailZ — L 7
. ;_-= Department of Fire Services Occupancy and Fee cked:
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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 12.00
City or Town of: YARMOUTH Date: /1 :5/02e02 L/
To the Inspector of Wires:By this application, a ndersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&N ber): J Unit No.:
1
Owner or Tenant: 3 L' i Email: .' C/3-4e iQ yt to i`'i 0 0/
Lt
Owner's Address: 3 �'�, //t�Qd d I l vtQ.y�/i ,lit, . Phone No.: 7RI- hj/..2 9 3�j3
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No Permit No.:
Purpose of Building: Rest Seij c C Utility Authorization�No.:
Existing Service: 0 Amps / Volts Overhead 0 Underground L� No.of Meters:
New Service: Amps / Volts Overhead 0 Underground/ 0 No.of Meters:
Description of Proposed Electrical Installation: aiQ 0 t AI /C,'rr u e'.� ...)/1ekreV yt n tee v (- a 4110 J
! w2'f l `1 13 tie/ . pA a r"e cE'�QD��lE'I -sic lr c SIPS/a� O'e�re ,l a��1S
Completion of the following table may be waived by the Inspector of Wires. (&sem cr1'4
No.of Receptable Outlets: 9 No.of Switches: !/ Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: p No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters:/ KW:9,5 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-Grnd.❑ Above-Grnd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
No.Air Conditioners: Total Tons: 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 E
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 0 Level 2 0 Level 3p<Rane F J V E D
OTHER:
FNOV-0-5-2024]
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical'iVork: .fib/'). 4'4-. (When require b o 1' •
Date Work to Start: / ?C Inspectigns to be requested in accordance with ME Itile-I-8_.and-u••1 comn leTi .
..%vI-NAME: &,ii ! ✓ CS t-Za/41 / A-1 0 or C-1 0 LIC.No.:
b,•
Dcts /( 1 5 CA 1S'/1D irk LIC.No.:
Journeyman Licensee: LIC.No.: _
Security System Business requires a Division of Occupational Licensure"S"LIC. / /'(S-LIC.No.:
Address: 3 5 fir/1„i„,, c /y r. 4 f�ZeSq VI A/s/ 4 75
Email: c/�1C`hS 0Mn1 /7Fel(- 9 /144/ . corn Telephone No.: 7F/-z-h,z5'-73hi3
I cert f,unde the ain nd pe Dies erjury,that the inforation on this application is true and complete.
4 ieertsers: � �rcGt( ��h 6 Print Name: 4a's'L e/,.,/ C.Ms`lid 1/4Cell.No.: '7 t'- 702%?3'/3
INSURANCE COVE 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 same to the permit issuing office.
CHECK ONE: INSURANCE❑ BOND 0 OTHER❑ Specify:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance,c.overage normally
required by law.By my signature below,I hereby raive this requirement.I am the: (Check one)Owner Owner's agent 0
Owner Agent• Da n‘ .. ( _..[ a2t2t
Tel.No7 / / %-Email.:Ckl/1 C'`j>S!,'D6t,/' ii'Rev /YIt;it di''t