HomeMy WebLinkAboutBLDE-25-251 Commonwealth ofOfficial Use Only
•Massachusetts -- I
PermitNo. �?�— 2�.•�
.14, Department of Fire Services Occupancy and Fee Checked:
.'�w=�.— " BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/2023] •
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
v\ All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
- City or Town of: YARMOUTH Date: 2- / 6/z 5
To the Inspector of Wires: By this application,thc undersigned gives1notices of his or her intention to perform thc electrical work described below.
Location(Street&Number): 4 2 'Act to se-1- r 4 Unit No.:
tti Owner or Tenant: L is A FAA-0 e r Email:
Owner's Address: Phone No.: 5'0 tS 3 6 7 $d 3 Z
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ Na Permit No.:
CO
o Purpose of Building: Utility Authorization No.:
sExisting Service: I b v Amps 1 ZO/ ' Volts Overhea. Underground[3 No. of Meters: I
. co„,New Service: 1 S Amps I l.0 / W)t Volts Overhea._n Underground El No.of Meters: )
Description of Proposed Electrical Installation: r- e U f a Cc hn G V a r) A r Y1 I
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-Grad.❑ 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 Equipment:
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level I 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as requi(e�ed b the Inspector of Wires.
Estimated Value of Electrical Work: ')..6 (When required by municipal policy)
Date Work to Start: —7_,/ C / 2.r' Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: �/) 4 1614/ sr)Co(i/is Y1. A-I ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: J LIC.No.:
Journeyman Licensee: 14�1 4f` t//'1 G 14/ �a l /1 3 LIC.No.: 55 3 O-g
Security System Business requires a Divis'on of Occupational Licensure"S"LIC. S-LIC.No.:
Address: __ �d �q-5 Sid Ave 'I PO 1 h L7
Email:Al 4, 0o r O ;1 . 0 by Telephone No.: 22 e/f j1077
I certify,under the p i s and 1 ' ry,that the information on this applicatiot is true and complete.
Licensee: Al Print Name: dYJ.4"e,412, g6 Oy1 Cell.No.: ,-de,c±yr77
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the Iicensee
. 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: INSURANCEZ— OND❑ 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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