HomeMy WebLinkAboutBLDE-23-1709 #B e4'h
Commonwealth of Massachusetts Official se onl 9
Permit No.: r— -- I ! CJ
(;tfr
Department of Fire Services Occupancy and Fee Checked:
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: Il/1/da'J
To the Inspector of Wires:By s plication, a undersignedgives notices hisher intentionperform the electrical work described below.
Location(Street&Number): (D 9(Cf of or to
Ave._ Unit No.:
Owner or Tenant: 00r0 Mk Email:
Owner's Address: �,,{ Phone No.: Gi l-� C'15-553i
Is this permit in conjunction with a building permit?(Check appropriate box)Yes N 1 No❑Permit No.:
Purpose of Building: Ova:4,- Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: 14wndNL e,k4italI DA ex`siA s:aI'1 d44
re 0-44 k -h mil 51(1;9 , a 1013, 1,44er se 5 oak, ' r P.Q5k
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 0 No.of Devices:
Swimming Pool:In-Grad.0 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 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❑ Level 1 ❑ Level 2❑ Leve 3 k ,h a g:E V E D
OTHER: I —_.._..v—
Attach additional detail if desired,or as required by the Inspector of Wires. NOV 0 1 2024-
Estimated Value of Electrical Work: if t,ot)n (When required bJT munici•. .olicy) —
Date Work to Start: Inspections to be requested in accordance with MEC ieN, .•• 1366aTcleatiliti)n.
FIRM NAME: StleC1 UC, w, CO 61 cottilk Cala'''1t+ A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: C Ti. LIC.No.:
Journeyman Licensee: Ke AAA $iI Irk Tr. LIC.No.: 5 3 9 2 g
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /4°S/L 93 (7' chi t)/ ,(4i
Email: Telephone No.: �J
I certify,and th pains d penalties of perjury,that the i orma ' n o this application-t is true and complete.
Licensee:�� Print Name: �e1 � S%Lit, cl- Cell.No.: 771- 716-7541
7
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of liability including"co pleted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of e to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER El 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 0
Owner/Agent: Tel.No.:
Signature: Email.: