HomeMy WebLinkAboutBLDE-25-537- Commonwealth of Massachusetts Official Use Only_
Permit No.: 26—S` 37
' Department of Fire Services Occupancy and Fee Checked: l
`I' BOARD OF FIRE PREVENTION REGULATIONS [Rev. Ino23J •
-‘' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W RK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 1 . Q
City or Town of: YARMOUTH • Date: Ll
To the Inspector of Wires:By this 'cat' a un` rsigned gives no ices of is o icr intention to perform the electric work des ribed below.
• Location(Street&Number): t b f t(it/ Vl a/l i Q(. (l T of t 1/e Unit No.:
Owner or Tenant: J °•e L/ (faro Email:
Owner's Address: 54afilLQ Phone No.:
Is this permit in conjuncts n with,"building permit?(Check appropriate box)Yes❑ No$Permit No.:
Purpose of Building: Lu/e11149 Utility Authorization No.: g-oN6-7 it fi
Existing Service: 0 Amps/ / d '•Volts Overhead 0 Underground No.of Meters:
. New Service: Amp )1() / Volts Overhead 0 U ergr nd D No.of Meters:
Description of Proposed Electrical Installation: e/mover "eft?C'1? • e6u4T
. a OKId f /
1
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 0 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 0 No.of D ' _
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equip ei E C E I ,` E D
No.of Modules: Roof-Mount El Ground-Mount0 Level 1 0 Level 2❑ Level 3 Elt' — e_i ..
OTHER:
__ __ _AP.1 &_2025_
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electri 1 Wo : (When required by UItIIfl IMIiWPARTMENT
Date Work to Start: Inspections to be requested in accordance with MEC Ru •, . . T. -
- FIRM NAME: A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.: Z
Journeyman Licensee: gl 0,Q/ '/7C LIC.No.: J c�j
Security System Business r uires a Divi 'on of Occupational Licensure"S"LI . S-LIC.No.:
Address: -'4' Ur J el e 04 ,1.P• W ✓, g( " Q5J
Email: ' G ,1 r /0 I 1 • Telephone No.: (' 2 (�
I cerifft,u the pains t enalties perjury,that the ' 'siltation of Cis applica on is true and complete.
Licensee I Print Name: O 1, �j Ige Cell.No.:7 7 , 9 R y
INSURANCE COVERAG : nless waived by the owner,no pennit for the perfotrhance of electrical work may issue unless the licensee
provides proof of liability includi g"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof f e to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 Specify:
OWNER'S INSURANCE W IVER: 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❑
Owner/Agent: Tel.No.:
Signature: Email.: