HomeMy WebLinkAboutBLDE-25-204 ._ Commonwealth of Massachusetts official Use Only
Permit No.:(��
it 1i!;_^ Department of Fire Services Occupancy and Fee Checked:
=. '11= y BOARD OF FIRE PREVENTION REGULATIONS [Rev. t/2023] •
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 C R 12.00
City or Town of: YARMOUTH ' Date: oZ // 25
To the Inspector of Wires:By this application„lt undersigned gives notices of his or her intention to perform the clectr. al work described below.
• Location(Street&Number): 33 Aki r Al A91I') Unit No.:
Owner or Tenant: G eec DilV/S Email: �4-Gk Cr;-'V,%, �`e c C•AIGICS7 A4-7
Owner's Address: . V Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: GrCI1 Utility Authorization No.:
Existing Service: 07,6 o Amps/ZO &V Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: /41OV p/LS.5 * -5L
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 DevtL.ces:
-.u..
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipme°tt:R E C I V E D
No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ R*tom:
OTHER: FEB 0 4 2025
Attach additional detail if desired,or as required by the Inspector of Wires. W y I
Estimated Value of Ele tri l Work: (When required by mui M4�b74�ypEPARTMENT
Date Work to Start: //9/ as- Inspections to be requested in accordance with MEC Rule Wt);-and-upoiteerimplotion;
FIRM NAME: � G r, , i-p ,v1 A-I ❑or C-1 J❑� LIC.No.:
^,,
Master/Systems Licensee: LIC.No.: /✓I g 1/
Journeyman Licensee: • LIC.No.: t c7S 9'1 9
Security System Business requires a Division of Occupational Liccnsurc"S"LI Via
No.: //
Address: c2 `��s4 t.),NA4 t tS. V)4>f/01D y o�U S "
Email:T- 6;1 -1-6,-)s /e G'7-yL1 c res. 04..d, i� Telephone hone No.: `92F-! / 'c, J/
I certify,under the r penalties of perjury,that the information on this ap l• anion is true and complete.
Licensee: Print Name: V:2.- .f\ t6,-/ )4 Cell.No.:,97- y7q-c,2j`�-/f
INSURAN C RA :Unless ived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proof of ility including"co leted operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and h exhibited proof of s e 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.: