HomeMy WebLinkAboutBLDE-25-687- R�ECEIVED
14 Commonwealth of Massachusetts Official Use Only 5 (/
MAY 2 ,,,,:.._;.�, PermitNo.: 5L. C-A (xi
"`-' . � � Occupancy and Fee Checked: //
...1.-�! Department of Fire Services
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4= -+ •iz RD OF FIRE PREVENTION REGULATIONS [Rev I/2023] •
BUILDING [t _
" `' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 1 0(L
City or Town of: YARMOUTH 0 Date: lA a// 45
To the Inspector of Wires: By this application,�} the undersigne ,gives noticcs of his or her intention to perform the electri a! l work described below.
• Location(Street& um er): /D /V, JSc VSo(l. r'�iM y Unit No.:
Owner or Tenant: Db s'\ N 1 SC Email:
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No[' Permit No.:
Purpose of Building:, Utility Authorization No.:
Existing Service:_ Amps/4C) / Volts Overhead a Underground❑ No.of Meters: I
New Service: Amps / Volts Overhead❑ Undergro nd❑ No.of Meters:
Description of Proposed Electrical Installation: 14 t h'R '{l,F i10CA&,Ln
4_,
Completion of the following table may be waived by the Inspector of Wires. .
No.of Receptable Outlets: 6 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:to-Grnd.0 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 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 0 Level 1 ❑ Level 2 0 Level 3❑ Rating:
OTHER:
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Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: G...- ' ' ) (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-1 ❑or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee Ut) \ / LIC.No.: IZ 3
Security System Businesss requiresui a Division of ccupatiional Liccnsurc"S"LIC. S-LIC.No.:
Address: ' ,0• I k,l'c 6 )--16P I `(,h I. 't-/� _
Email: A ,`k�y. (� ,r t i ;( � 7f 1 Telephone No.: ,� /�
I certify,u e the pal n 1, tallies of perjury,that the information ost this Ipplication is true and complete. � j��
Licensee: b/�it c / Print Name: YO})tc/ W I 1 R c / Cell.No.:,,6- ,,:e "Y�?L/'
INSURANCE CO ER• • nless waived by the owner,no permit for the performance 6f electrical work may issue unless the licensee
provides proof of liability incl ing"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: INSURANCE p. BOND❑ OTHER 0 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❑
Owner/Agent: Tel.No.:
Signature: Email.:
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COMMONWEALTH OF MASSACHUSETTS
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN
DANIEL O WILKEY � .{
168 CENTER ST W
SOUTH DENNIS, MA 02660-3744
( J
32288 E 07/31/2025 268634\
SENSE NUMBER EXPIRATION DATE SERIAL NUMBER