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HomeMy WebLinkAboutBLDE-25-761 5-0.O0 _ ._ Commonwealth of Massachusetts Official Use Only _:•• - Permit No.: -J.11_ Department of Fire Services Occupancy and Fee Checked: -2 '; V.fi 'I BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] • '`'•— APPLICATION FOR PERMIT TO PERFORM ELECTRICA W RK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 0 City or Town of: YARMOUTH • Date: To the Inspector of Wires: By this application, he undcrsi ed gives tic f is or her intention to perform the electrical ork d cribcd below. • Location(Street& mbe ): Unit No.: Owner or Tenant: (4, ©•5 4 Q Email: Owner's Address: t,41 e - Phone No.: Is this permit in conjunctio ith a Wing permit?(Check appropriate box)Yes❑ No❑Permit No.: Purpose of Building: G//I (/4 Utility Authorization No.: Existing Service: / 5 0 Amps �/2 WVolts Overhead Underground❑ No.of Meters: /New Service: Amps / Volts Overhead ndergro nd No.o eters: i Descriptionof Proposed Electric 1 Installation: f f/ (i�/ �cG �� a/, s T � 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.❑ 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❑ Ground-Mount❑ Level I 0 Level 2 0 er 3 R c g1 V E D OTHER: C �� ----_. — -- Attach additional detail if desired,or as required by the Inspector of Wires. J U Estimated Value of Electrical Work: (When re it d by municipal olic Date Work to Start: Inspections to be requested in accordance witl:I CtRtiNC10;ht$ epWiU rIp etion. By — --- - FIRM NAME: A-I ii . - ■ No.: Master/Systems Licensee: I / LIC.No.: Journeyman Licensee: 4d /7G 4 - LIC.No.: ?ci07 Security System Business requiges a Division f bccupational Licensure"S"LI . S-LIC.No.: Address: `7 1e f f r liQri ( .. le/- t,// © 4"• 4'c,l 71 Email: © r • Telephone No.: r- 7)4 I certify,un the pain i enaltle perjury,litat the i ration of Iris applic lion is true and complete.u t� Licensee. "u' � �/ Print Name: 4",�4� C Cell.No.: 7y/ . " ?-973U INSU COVERAGE: nless waived by the owner,no permit for the perfortfiance o 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 of s e to the permit issuing office. CHECK ONE: INSURANCE BOND El 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: Email.: COa.�a�b) ®F•MASSACHUS'ETTS '!VISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS ` '1 ISSUES THE FOLLOWING LICENSE REG JOURNEYMAN ELECTRICIAN EDWARD M LYNCH �N 23'MDGEON LN • • < w WEST YARMOUTH,MA 02673-3818 W 35609E 07131/2025 377314 N ie r �la�i (9Arju iumemaI_e�;.9I51:3�:�