HomeMy WebLinkAboutBLDE-24-1872 Commonwealth of Massachusetts Official Use O ly Permit No.: t 'L%{—I '1 Z
it= >r�; 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: 4:-
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): 9O9 64. ?5/ ;��//rlcLij( KO Unit No.:
Owner or Tenant: pined C,112 t-q ei S-I Email: Im 6 sl•ten eiec ic,c'ut-Jo 00y,txf4{,6--t...
Owner's Address: i Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No,®Permit No.:
Purpose of Building: /2/01.5 Utility Authorization No.:
Existing Service: %V C Amps/20 WO Volts Overhead a Underground❑ No. of Meters: /
. New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: ReuSi 14tttievi '1 J JuC?t.J titynot 4 i)))
14 Q.e 55 j tit4 /191) 'Veined 11ahCe Ct'./k. is .
Completion of the following table may be waived by the Inspect r 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:to-Grnd.❑ 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: Total Tons: Telecom System 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of17 celL r r i V r b
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipm �:: .
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 ❑ Level 2 0 Level 3 ElRtzt►ng:
OTHER: DEC 04 2024
Attach additional detail if desired,or as re�uired by the Inspector of Wires. B U l l_D I N G D r_PA RIM E N T
Estimated Value of Electrical Work: J'-Ca e . (When required by ttltticipal policy)_._.___ -- •
Date Work to Start: /,11-2Y Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: /"ItCl c,¢f(A11t!¢✓t t ee14440n 1,vc • A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 1/1"'4C11€f€f (A ck.1. LIC.No.: / 3 41.22 a
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /5.5,3 oi/eket S leU tI1y6oc- is t 07C 9 S`
Email: Pi. t~45 t.e-Ott;>feem i.k•n.Q 4 t, I'oh! . ( - Telephone No.: /.7 y Z/? /8ZS '�
I certify,under the ns a penalties of perjury,that the information on this application is true and complete.
.,
Licensee: ' L.PrintName:04 4e ( (' -- Cell.No.: 7 741-2/2-7¢1'2-
INSU N E CO RAGE: 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 me to the permit issuing office.
CHECK ONE: INSURANCE J 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.: