HomeMy WebLinkAboutBLDE-25-250 Commonwealth of Massachusetts Official Use Only
Permit No.: 2_,5--— Z S-0
>�; - Department of Fire Services Occupancy and Fee Checked:
I'" `'" 4 BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/2023]
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- APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
l.;rC All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH Date: / /z 5
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I i^,To the Inspector of Wires:By this application,the undersigned gives oticcs of his or her intention to perform the electrical work described below.
(, W Location(Street&Number): 4 �- tnq to 5c�' r Unit No.:
': Owner or Tenant: L i S A tl e r Email:
g dtvner's Address: Phone No.: .5 4 e - .4'7 $ D 3 L
m hsiithis permit in conjunction with a building permit?(Check appropriate box)Yes El NcZiPermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: I b Amps 1 Z°/ 1. Volts Overhea07 Underground❑ No. of Meters: I
New Service: \ a ZS Amps 11 0 / Wi Volts Overhea. I Underground❑ No. oftMeters: 1
'
Description of Proposed Electrical Installation: �44 . 1Me�( it �� p'Pl hC
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 El 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 0 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❑ Level 1 ❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as requi ed b the Inspector of Wires. '__
Estimated Value of Electrical Work: /.e O (When required by municipal policy)
Date Work to Start: —2./ C /2,rj Inspections to be requested in accordance with MEC Rule 10,and upon completion.
- FIRM NAME: Ai.. q ttl y/ Cc)ed Y\ A-1 ❑ or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 1-4'1 4-ell 14 i o l----(94 LIC.No.: 5-Ce3 v-g
Security System Business requires a Diviss''on of Occupational Licensurc"SS,"LIC. S-LIC.No.:
Address: __ 6-6 �al'5-5; Ave I�Ct'')( 1 ni li L lj
Email:/Vl 41r. C. 60d-ip 0g t1 evi or:1 ,GCSyV1 ' Telephone No.:227 e t'67�69072
I certify,under the p r s and t ' ry,that the information on this applicatiot is true and complete. ,j-
-
Licensee: /4'7 Print Name: '4/A/r.M &1 On Cell.No.: J�Qe'c�(/
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: INSURANCEZ BOND 0 OTHER[I] 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 0 Owner's agent El
Owner/Agent: Tel.No.:
Signature: Email.: