The URL can be used to link to this page

Home My WebLink AboutBLDE-24-1702 Pd 3-t.60 Commonwealth of Massachusetts ;official Use O�glx z _Pi_ ,_ = t (( G Permit No.: 1g!__, Department of Fire Services Occupancy and Fee Checked: I!'=-" BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] ^ ` APPLICA ON FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be pe rmed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00 City or Town of: YA R M O UTH_ • Date: 1 D O L/Da 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): ) t-11 Zd6Cr\. 1- "C Unit No.: Owner or Tenant: >e_PI•. 17a n i J Email: Galet o n)o`1-5©yMr-t•I-c0.`7 Owner's Address: 5401c. QS az ft, Phone No.: ,sod, - K6t-l- 177 7 Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑ Permit No.: Purpose of Building: Ut' ity Authorization No.: Existing Service: 'p 6 Amps / Volts Overhead nderground 0 No. of Meters: ) New Service: D 00 Amps / Volts Overhead pi Underground❑ No.of Meters: Description of Proposed Electrical Installation: VP Jf 4(11 e)y Saki,C.e. '0 L`' -" PS 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❑ 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❑ 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❑ Ground-Mount❑ Level 1 ❑ Level 2❑ Level 31 nn £ 1 V F D OTHER: ---____.______ Attach additional detail if desired,or required by the Inspector of Wires. OC 2 02 4 Estimated Value of Electrical Work: 0 T 4,i)00 (When required by municipal policy) Date Work to Start: )0 I a`i\I LI Inspections to be requested in accordance with MEC IO Lib;Veil-UV-di ighti6lgon. FIRM NAME: A-1 0 or C-1 ❑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 certfy,and the pal nd penalties of perjury,that the information on this application is true and complete. Licensee: Print Name: OSC ' ' ,u@ 0 i c) Cell.No.: ljb 6-`g61LI-1 7 7 7 INSURANC OV GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof f liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force and as 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.: Signature: Email.: