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Home My WebLink AboutBLDE-24-1757 RECEIVFDI NOV 0 7 2024 i -_ - Commonweal'hdf hel htisT�tt T Official Use Only, __... Permit No.:C=l2-C 1'7 5 -- 4;' Departmenni ire ervices Occupancy and Fee Checked: --`.11:�° 'BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] • ''• APPLICATION FOR PERMIT TO PERFORM ELECTRICALWORK All work to be performed in accordance with the Massachuset Electrical Code(MEC) 52 M l 00 City or Town of: YARMOUTH iw's• , Date: ? To the Inspector of Wires: By this appli atio t c un ..:,na: iiiiiy'1 c •f his• h/t. tic,t.perform the deck cal wor described Clow. • Location(Street&Nymber): /r_ V �,&t ►i .��C// Ati,:L41' Unit No.: Owner or Tenant: (/'p C/4 - &67 J Email: Owner's Address: Phone No.: Is this permit in conjunctigp with building permit?(Check appropriate box)YesJ No❑ Permit No.: Purpose of Building: /2'tl/9/'/ 9 Utility Authorization No.: Existing Service: m / Volts Overhead 0 Underground❑ No.of Meters: New Service: Amps / Volts Overhead Underground❑ No.of Meters: De ription of Proposed Elec at Installation: C ew 1/led .' it ©le � P1' 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 ❑ No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 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 0 Ground-Mount 0 Level 1 ❑ Level 2 0 Level 3❑ Rating: OTHER: Attach additional detail if desire ,or as required by the Inspector of Wires. 'W Estimated Value of Ele9tri rk: (When required by municipal policy) • Date Work to Start: /( 9. . Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: A-1 ❑ or C-1 0 LIC.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: pa (,7/Y1 1.. d C . LIC.No.: 3 5'6 c7q Security System Business req 'res a Division of Occuional Licensurc"S"LIC. S-LIC.No.: Address: a 1 by,' 9,(90 Lai c?/(Ioc'/f Mq r Email: 1T�Telephone No.:. J 3g' I certify,and ne pain a enaltl .of perjury,that the in o nnation on this applical on is true and complete. Licensee: Print Name: �� L. /JG Cell.No,: 3� INSURA C COVERA E: nless aived by the owner,no permit for the perforce of tetncal work may issue un ess 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 f ame to the permit issuing office. CHECK ONE: INSURANCE BOND 0 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.: