HomeMy WebLinkAboutBLDE-25-383 Commonwealth of Massachusetts Official Use Only -
Permit No.:
.>i+, i Department of Fire Services Occupancy and Fee Checked:
=. 11-- " BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
V`''• 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: YARMOUTH 0 Date: ! vim (.- . ( ` � 7-e'z.J
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): 7 U (EPA i 2✓4 4-t.r- (2y Unit No.:
Owner or Tenant: &Lie-Q d-- �-1 Sq LA. (i v--qpe-{ I Email:
Owner's Address: "7 D .. e N ct -wt ('� ) Phone No.:`E I'� -3 ( - O'f 7
Is this permit in conjunction with a building permit?(Clieck appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: u�t.,l.t.,\3 Utility Authorization No.:
Existing Service: / t�v Amps/Z& !2. `-(OVolts Overhead❑ Underground❑ No.of Meters: /
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: .2-- C w �. t-C b L<✓�,� t + ✓
ex Ct )00. '. ( U lb,., ( vcc C q (( --CV G- 0 4 )
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.❑ Above-Grnd.0 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 I 0 Level 2❑ Leveh3❑ Ratmg: E I V F D
OTHER: _ _. __.�_.
Attach additional detail if desired,or as required by the Inspector of Wires. � �'
Estimated Value of Electrical Work: (When require, IV municipal policy)..- •
Date Work to Start:Piety-6L� (9 Inspections to be requested in accordance with MB C Rule 10,and uponponrvcompretio .
FIRM NAME: / A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.: /
Journeyman Licensee: �(,,, i f 4q 55 LIC.No.: -3 B- 1 �b e-
Security System Business requires a Division of Occu tional Licensure"S"LIC. S-LIC.No.:
Address: `2--S- '( kz emsu C{--I ,. 1:7c--wk,1 S /./(A 0 Z-((c D
Email: f�ex sa_
,� r i�vLt �S/_, vt.`e__--f--- • �O Telephone No.: a.' 22 I -O SL}�j
I certify,under the pains a,d penalties of perjury,that the information on this application is true and complete.
� lZ%�,���vy p
Licensee: Print Name: SO �✓� (Z F ��5�-7 Cell.No.: j o$-27( -vg({1
INSURAN COVERAGE: Unless waived by the owner,no permit for the performance of electrichl 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 o . to the permit issuing office.
CHECK ONE: INSURANCE it: BOND❑ OTHER❑ Specify:
OWNER'S INSURANCE W,. VER: 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.: