HomeMy WebLinkAboutBLDE-25-616 RECEIVED
MAY 09 2025 )t.
_�� Common wealth of Masse t�EPARTM N'�rrtit No.: /)fO3€c Ct`�—CO(to
�ai�i Department of Fire ''pl�lii ciapancy and Fee Checked:
'• h+n�l n 1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. !/2023] •
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL ORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 M 1 00
City or Town of: YARMOUTH Date:
To the Inspector of Wires: By th/ii a Ilea' ,the and.gig ives ticcs of his or her intention to perform the electrical ode escrihed below.
Location(Street&N iber): �+ ` nit N .: / • �"
Owner or Tenant: /(� 4�'rt/l, Email: n i/�/1/y�(�4 ep f LL�G// ,Lei
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Owner's Address: � , Phone No.: !
Is this permit in con unction with 3 ilding permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: 1/j/e 7 Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
. " New Service: Amps / Volts Overhead❑ Und/ergroun ❑ No.of Meters:
Description of Proposed Electrical Installation: �� /' ��/ / �J��
Completion of the following table may be waived by the Inspector of Wires. .
No.of Receptable Outlets: (,L No.of Switches: 7 Generator KW Rating: Type:
11
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-Gmd.❑ Above-Grnd.0 Hot-Tub❑ 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❑ Level I ❑ Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-I ❑ or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
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Journeyman Licensee: F /Ci /C/k. LIC.No.: 5 ( � �
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Security System Business requ'res a Divisio of Oe upational Liccnsure"S"LIC. �CNo.:
Address: l �i(//' ("®/� - Qf// t�'f7 y9/. 7
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Email / G Telephone No.: ??,
I certify,un he pains p Haloes o erjury,that the ' nuation onl his pplication . true and cons+�lete.
Licensee: Print Name: �A lj ('/ Cell.No.: / 7 , y-- yie
INSURAN E COVER GE: U ess waived by the owner, o permit for the performan 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 f me to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER❑ 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❑ Owner's agent El Owner/Agent:
Tel.No.:
Signature:
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Email.:
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