HomeMy WebLinkAboutBLDE-25-754 •
_ Commonwealth of Massachusetts ogfieial U o c_ ,-_ ,
, w_ : _ Permit No.: (...6-" ,Y, .-,
`' 4,- Department of Fire Services Occupancy and Fee Checked:
ii";::: V BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] '
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 112.00
City or Town of: YARMOUTH Date: `t �e 3'' z,c
To the Inspector of Wires:By this plication,the undersigned giycs notices of is or her i ten'on irperfon i t i c ical work described below.
• Location(Street&Number): 57 5 t1{-pil tk 0 , Qt \_U_nit No.:
Owner or Tenant: ��;yumcW.t, 0'L'IA t CV 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 / Volts Overhead❑ Underground❑ No. of Meters:
New Service: Amps / Volts Overhead❑ �Jn4erground� No. of Meters:
Description of Proposed Electrical Installation: NA Q.11 Tif.dce. (�' /
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: E D
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: JUN 03 2(25
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 De ice
VBUILDING utHAF,TMENT
C No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices: 8
�' No.Air Conditioners: Total Tons: Telecom System El No.of Outlets: —'
."t No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount El Ground-Mount ElLcvet 1 ❑ Level 2❑ Lcvcl 3❑ Rating:
e OTHER:
Attach additional detail if desired,o as required by the Inspector of Wires.
Estimated Value of E ical Work: 1. L U D (When required by municipal policy)
✓ Date Work to St OTA - Inspections to be requested in accordance with MEC Rule 10,and upon completion.
J. FIRM NAM t i /%1J itu A-1 0 or C-1 0 LIC.No.:
d Master/Systems Licensee:/..7
LIC.No.:
Journeyman Licensee: Jof iQ f-t ��� li J,�
l }� LIC.No.: \ eb)
Security System Business requires a Division of Occupational Liccnsure"S"LIC. S-LIC.No.:
Address: 3i ,R fi yl 1)` 1 plp7, IYA �Z7o
Email: .N.il1,1 rt1G' Telephone No.: D t qv ir" 'n P � "T t�
I c fifty,u ai nd penalties of perjury,that the in ornnation on this application is true and complete.
Licensee: j,w, Print Name f,. 604 UtN Cell.No.:OB \t'gt e-
INSURAN E COVE AGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides proo of liabili including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force an has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ 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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
-it) COMMONWEALTH OF MASSACHUSETTS
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN --3a
JARLATH A GALVIN
840 ROUTE 6A
YARMOUTH PORT,MA 02675-2045
10861 B 07/31/2025 332640
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
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