HomeMy WebLinkAboutBLDE-25-436 Commonwealth of Massachusetts Offfiic alUseOnly,
Permit No.: 1.
ti -. F. Department of Fire Services Occupancy and Fee Checked:
^ e ". BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/20231 •
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 Date: Apra 1, 25
To the Inspector of Wires: By tins app ication,the undersigned gives notices of his her intention to perform the electrical work described below.
Location(Street&Number): 37 L oron S>r `p e) -, Y,P0CT Unit No.:
Owner or Tenant: ZI phf (1')b y ft 11 gig n Email:
Owner's Address:/&. 1.14.0 k LA. f eili'Rirl�1�1 m Phone No.:
Is this permit in conjunction with Juildi g pe t7( ec Appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: O11� FF tA,ly zit'n Utility Authorization No.:
Existing Service: /OQ Amps/ /t290 Volts Overhead I Underground❑ No.of Meters: 1
" New Service: Amps / Volts Overhead_ ❑ Undergrounde ❑ No.of Meters:
Description of Proposed Electrical Installation: lAYI' t j�¢ (P}jq- / FI:"t,Y r`)
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Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: /( No.of Switches: t 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 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 0 Level 3 ❑ Rating:
OTHER:
Cf2dC I 7V _ ____ _________
Attach additional detail if desireJilt(
,or as re uired by the Inspector of Wires.
Estimated Value of Electrical Work: .
,�,��,.,�,,,11 i (When required by municipal policy)
Date Work to Start:v�fhe%k 2.7 Inspections to be requested in accordance with MEC Rule 10,and upon completion,
FIRM NAME: A-1 ❑or C-I ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: C, ��ii L�TY LIC.No.: 3 ' 7 E.
Security Sysf Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 1 .6 ,(,/�`'o!C fe - rfr\A .
Email: 1...).4 6.
Telephone No.:, ce, t-' 36
I certify,u r he p les of perjury,that the information on this appfica ion is true and complete.
Licens Print Name: C G' L `
INSURA ERAGE:U ess waived by the owner,no permit L I - . . " C 9/ Cell.No.: SOC7—,% �y�
provides proof of liability inclu ' "completed operation""coveragep nit for the performance of electrical work may issue unless the licensee
p or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited roof of same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND 0 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 0
Owner/Agent:
Tel.No.:
Signature:
Email.:
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