HomeMy WebLinkAboutBLDE-24-1689 Commonwealth of Massachusetts c s, tCJ
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Permit No.: Of (
.>11!-- � Department of Fire Services Occupancy and Fee Checked:
`- --`a'--e 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 appli ation,the undersignetgives notices of his or her intention to perform the electricalllworrk descr b low.
Location(Street&Number): 7 TAN t t-t NOaD DRAE Unit No.: 6 7o?+ � ibed0 _
Owner or Tenant: 1Y1I V 66-'4'`�
nan . � • Email:
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No❑Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: I b0 Amps 1,-0/ ) Volts Overhead❑ Underground 0 No.of Meters:
New Service: 3O0 Amps 00 / Volts Overhead Ea Underground 0 No.of Meters: I
• Description of Proposed Electrical Installation:
61TEn AID 5 FP- I;C.: 0k-41')& -
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-Grnd.❑ Above-Grnd.0 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❑ 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 0 Level 1 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: i ANIth j\ r C c (,C A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: \\ LIC.No.:
Journeyman Licensee: :). AN-0 1 1 (COIL LIC.No.: 3-7 SS-F
Security System Business� requires a Division of Occupational Licensure"S""LIC. S-LIC.No.:
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Address: ) fl2 E PflAbd-) c 1. E S.-V b ,7,5. 6 y
Email: c O 1 t 5 C C.m M C.C•-S-E —IA ej Telephone No.:. �+S^391{-6931
I cert f, er the pis a pi en,ltie f perjury,that the information on this application is true and complete.
Licensee: — t 40.0i Print Name: DAN 0 N (CSC LL Cell.No.: L-j 6 `3 b 0-7 3(.3
INSURANCE CO ERAGE: Unless waiv 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 0 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 my signature below,I hereby waive this requirement. I am the: (Check one)Owner❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: