HomeMy WebLinkAboutBLDE-24-1839 Commonwealth of Massachusetts MIT e Only/ 3�
Permit No..t' Eii
__,-�>ri;_ ' Department of Fire Services Occupancy and Fee Checked:
=. 4' BOARD OF FIRE PREVENTION REGULATIONS (Rev. l/2023J •
`''• 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: //'2— "
To the Inspector of Wires:By this appl' ion,the un�dersigncd vcs notices��of1)''is or her)Mtention to perform the electrical work described below.
• Location(Street&Number): / / 7 / U e 4r f _ 2 r L T Unit No.:
Owner or Tenant: \-7i2e -, 4,-Q, Z Email:Cq/t k•^' /(S 10y h' '*A c 5"
Owner's Address: / 5-7,,7 74-c Zt 5 f.-tc Phone No.: 9'>g 3 02/°
Is this permit in conjunctpn with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: /5,z424 Utility Authorization No.:
Existing Service: Amps I Volts Overhead 0 Underground❑ No. of Meters:
New Service: Amps / Volts Overhead D Under round❑ No.of Meters:
Description of Proposed Electrical Installation: 1 ,7 " c C. `-� ''����o�'
/` ,e
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: 2 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-Grad.❑ Above-Grnd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Tctal Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Device "—
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment l'- _•
�,.. 3 0` _
Li
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1 0 Level 2 0 Level 3❑ Rating; vCJ
OTHER: ' NOV 25 2024
Attach additional detail if desired,or as required by the Inspector of Wires. l ,3;I,i DIN(' u E { r .I_r
Estimated Value of Electrical Work: (When required by municipal.pnliety) ----.-
Date Work to Start: //,3—02Slnspections to be requested in accordance with MEC Rule 10,and upon completion,
FIRM NAME: A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman r Licensee:' -7 tc7 - /V a 5'(/1--",l '4 -lie LIC.No.:- /70 Z y
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /10 A/ to 2// ,-L. 3 -
Email: Telephone No.: 1.0 S 7 y /d 7
I certify,under the pains and penalties of perjury,l/tat the information on this application is true and complete.
Licensee:'17G ,- /a 5c/ , ,,t, <1rint Name: r--'a� v... �`�. Cell.No.: .2 J 6//.3-,,
INSURANCE CO y- �(VERAGE: Unless 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 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 mysignature below,I hereby waive this requirement.I am the:(Check one)Owner 0 Owner's agent 0
Owner/Agent: , aJr'
if'. /i-J 1, Tel.No.: J
Signature: 11"d {`l yc . tt Email.: C•,pt c 'ec/s 7 ti, 4-•-/ e