HomeMy WebLinkAboutBLDE-25-203 Commonwealth of Massachusetts �Offi [1se°may_
_;_- Permit No.: C, t� 1
.> i � Department of Fire Services Occupancy and Fee Checked:
- �= 4 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
yl'•—'° APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code 5 7 C(MEC), R. 12.00
City or Town of: YARMOUTH Date: - �L . / 3-�
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To the Inspector of Wires:By�th^is a plication,the undersigned gives notices of his or her intention to perform the electrical work described below.
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Location(Street&Number): 4 e- gyp'`( o---eso Unit No.:
Owner or Tenant: C- k-F(� 6 Zt Email:
Owner's Address: 64f C,C7 tJ i- .' ( 1" l.J Phone No.: __�
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 14 No 1::]Permit No.: c Pt 4 cr,
Purpose of Building: 5' (2._uo(r Utility Authorization No.:
Existing Service: ,,2( .3 Amps I O / Xz Volts Overhead❑ Underground I No. of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: ( .-e t) IV\, r22- AP, [= Nk
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vs). t (Z 1 J',/ L 0 - O S L-T Gir if t o0 2 AST t,>�('S t2 2 G t��
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Completion of the following table may be waived by the Inspector of Wires. I' f t S
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-Gmd.0 Hot-Tub❑ 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 No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equ' •
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2❑ Level 3 fat1g c s �l* . D ;
OTHER:
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Attach additional detail if desired,or as required by the Inspector of Wires. f
205
Estimated Value of Elec ical Work: yl f7OO oO (When required y,_4�v., '1': l-1wlii , •
Date Work to Start: . JL Inspections to be requested in accordance with MECcRu�le 1Q�Any,L•
d u �tQarikiiibNb .
FIRM NAME: iLity rill oOC)tl tx • PAID, & __.. A-1 0 or C-1 ❑LIC.No.: fr t
Master/Systems Licensee: LIC.No.: 33 c.P 1 —
Journeyman Licensee: -f(1y a)Qt� IA/&All
42Q! LIC.No.: j 3 Co , ] - 6-
Security System usin requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: vi (- fl �NIL( f ew
>t O , t j�`Email: ram �1Y)�l,�� I � � VEl. i Telephone No.:I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
• Licensee: Print Name: Cell.No.:
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 0 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 0
Owner/Agent: Tel.No.:
Signature:
Email.: