HomeMy WebLinkAboutBLDE-24-1756 Commonwealth of Massachusetts Official use only`n
,_--_ Permit No.: (���{ — J�F�
l�! -:l Department of Fire Services Occupancy and Fee Checked:
=- Il • -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 CM . 12.00
City or Town of: YARMOUTH_ • Date: 1 J i5 J
To the Inspector of Wires:By this application,the undersigned gives notic
es of his or her intention to perform the electrical work described below.
Location(Street& mber : "),(0 Q Crn ID 'Z Unit No.:
Owner or Tenant: rC.�✓1CCgn O r 0 Email: i1-f1dan 'l, Ec(Y)
Owner's Address: 3‹,,CGryb 3)i u JQ-i} LI arrnb4. Phone No.: Sb8' 9So 6I to
Is this permit in conjunction wttl9 a building permit?(Check appropriate box)Yes El No El Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead El Underground❑ No.of Meters:
Description of Proposed Electrical Installation: UL) c \ 11 4- e\echri CR t go,te 1 i. Qjt/ clha4-
pertii f. % fe M ? �,�/�e € ./r/xi-71= 6 LI)E.—,23--)ggq1
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Completion of the following 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-Grnd.❑ Above-Grnd.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 Tons: Telecom System❑ 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 Supp
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 Level 2 0 Le `guezit
• amgA V E D
OTHER:
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Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elec ical ork: 4 too (When reaug i3Yi#tgni fipgl prj_ T
Date Work to Start: I <)3 Inspections to be requested in accordance with I a_a up^^-co,i letion.
FIRM NAME: A-1 ❑or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address:
Email: Telephone No.:
I certf,under I e pains and penalties of perjury,that the inform Lion on this application is true and complete.
Imo: 'IV!'C jPrint Name: �� WIC '''n�� Cell.No.: _
INS RAGE: Unless w ived by the owner,no permit for the performance f electrical work may issue unless the licensee
provides r f of liabt ity 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 El 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❑ Owner's agent❑
Owner/Agent: Tel.No.:
Siii obit_gnature: �, Email.: br rA,A ,raj-5,co�
616 fur.5; AAti'e : ,