HomeMy WebLinkAboutBLDE-24-1888- Commonwealth of Massachusetts Official Use L
Permit No.: - 'L�{ —i S
F =`�!__f Department of Fire Services Occupancy and Fee Checked:
=Y 0- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023)
Im APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC�, 21 n 1_2.00
City or Town of: YARMOUTH Date: L '2J—\
To the Inspector of Wires:By this a licatio ,the undersigned gives notices of his or intention to perform the electrical work described below.
Location(Street& mber): Unit No.:
Owner or Tenant: Email: .5 ' ►A l- r V l (1 6m
Owner's Address: J1Th
0 1 ' / J Phone No.: -
Is this permit in conjuVion withA b tldin permit;(Check appropriate box)Yes 0 No t]Permit No.:
Purpose of Building: S1 L a I Utility Authorization No.:
Existing Service: ���� Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: '2 0 0 Amps / Z,Cdt)31ts ,, �( v 1 Ovverrhead Underground 0 No.of Meters:
Description of Proposed Electrical Installation: 2 OO W (S�(9, )
���J
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.0 Above-Grad.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❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 ep. p " D
k.Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Su 1 . m.it:IV,T! V ,___
No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1❑ Level 2 0 L vel 3❑ Rating:
OTHER: DEC 0 6 2024
Attach additional detail if desired,or as requiret1)
t tic Inecr of Wires. BUILDING DEPARTMENT
Estimated Value of Electrical Work: 1 ) (When re
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 112 G 6 JCtC i nC • A-1 eor Gl 0 LIC.LI� Mr-1 ) 1
Master/Systems Licensee:,�U(lAQ, U Q I 0 6 LIC.No.: 2 2 /0
Journeyman Licensee: DvC•�e, V r LIC.No.: F,T1 21D f
SecuritySystem Business requires a Division of Occupational Lie'sure"S"LIC. S-LIC.No.:
Address:y 1(Q "sea r_ p moat .J I T i,r / 72,11 ( 1
f'o � Sp o� 02 � �
Email: rOV C e .- nrka-,1 I . �/lTelephone No.: 50b ' 2 3r�- g(l�
I certify,under the ains and enalties of perjury,that ltlle informathrfi'on" fhis�a,plication is true and complete.
Licensee:,� U(,\Q. I LX� Print Name: Cell.No.: t- 939'eiLi
INSURANCE COVERAGE:Unless Waived by the owner,no permit for the performance of:I trical 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? BOND 0 OTHER 0 Specify:
OWNER'S INSURANCE W INSURANCE?
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.: