HomeMy WebLinkAboutBLDE-25-35 (2) RECEIVED1 LVersu,re tvo it0tder # �1 IG70i51b
� 1. Official Use Only
Commonwealth of Massachusetts
JA, , Permit No.: (:_ '^ S
4_, r'' Department of Fire Services Occupancy and Fee Checked:
BUILD! ±` . ri4OARD OF FIRE PREVENTION REGULATIONS [Rev. I/2023]
By ! y
„`- ._ 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: YARMOUTHI_ Date: ►/I✓/ 5
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): 3.1 Heirvc+r c1 5 y-ree r Unit No.:
Owner or Tenant: Mei ft i'V a tell e Email:
Owner's Address: 3,) H a r V a r(1 Srre er Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No 0 Permit No.:
Purpose of Building: Utlity Authorization No.:
Existing Service: Amps / `t' Volts Overhead 0 ,Underground 0 No. of Meters: /
New Service: ,4 L Amps . : / /L Volts Overhead❑r Underground❑ No.of Meters:
Description of Proposed Electrical Installation: I?cp/G<<P_ e/ec fr ea I Sc'✓d'lc; c/pfirctde to Do27 A,
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❑ No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grnd.❑ 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 ❑ 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❑ 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: /Y7 c *-'Fh e w 1CCt vc A-1 ❑or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: _67 rri c.Hhew %'G nr✓ LIC.No.: 55 30?g" 3
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: _-5 C 11CcrUurd 5t 5avkh Yarmavrfi n') Y3-- G.?btoV
Email: i')') Gi..+ k ct tit e 6)(' (.? ya,j1OO,co vi i Telephone No.: 7 7`t-QQ`'I-7 3 7()
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: Print Name: /VC *47 e(v /< C<in e Cell.No.: 7.7`/-9'f 4-7 3 T
INSURANCE COVERAGE: 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❑ 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.:
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