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Home My WebLink AboutBLDE-24-1766 r 7,5; a, 11,Sh Commonwealth of Massachusetts Official Use Only __,__ _ Permit No.: - (7 (4L:, 111!- Department of Fire Services Occupancy and Fee Checked: `'-- -ail- - " 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 CMR 12.00 City or Town of: YARMOUTH_ • Date: To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below. Location(Street&Number): -'C.-3/3 Tl,A 5 in a // • of Unit No.: Owner or Tenant: j/1,D5 N(.7/)ra (---e;D/f Email:g N/OA/C1/RP Ci)/i10n;,L , r,,,/, Owner's Address: Ic1lTa;',r 5i,.,,,J/ i- (Pi' 4417'3(dAP Phone No.: ,5o;l)g©d"3 /5 Is this permit in conjunction with a building permit?(Check appropri a box)Yes❑ No❑Permit No.: Purpose of Building: Utility Authorization No.: Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters: New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters: Description of Proposed Electrical Installation: 06 >,c e r-v(..),v1 rl sr c I;o. 01 t.' J r-k.11 Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets: L. 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-Gmd.❑ Hot-Tub❑ 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 ❑ No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equi. un. F D No.of Modules: Roof-Mount El Ground-Mount ElLevel 1 ElLevel 2 ElLevel 3 ElnF A�_ OTHER: F I Attach additional detail if desired,or as required by the Inspector of Wires. �� Estimated Value of Electrical Work: (When required by pun'iCipal pE3�id�+)'ARTMF NT • Date Work to Start: Inspections to be requested in accordance with MEC Rule40,-attet-upuii co►„p]ctiuit. FIRM NAME: A-1 0 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 certify,under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: O��G,� Print Name: /pm,'a 5 AZ9 4 v'.Q Cell.No.: S,,, ' $D,2 3/S INSURANCE CVEnless 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❑ OTHER❑ Specify: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law.By m_y signature below,I hereby waive this requirement. I am the:(Check one)Owner ErOwner's agent❑ Owner/Agent: ian,0) /V'v/1 rd Tel.No.: tr 2,2Z0 3/5- Signature: Email.:AN/O/ZU/ti/RlQ /7v/0►2;L . cows.