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HomeMy WebLinkAboutBLDE-25-741 RECEIVED �� �-5-7`Ii 41. Official Use Only M 029 ommonwealth of Massachusetts „_ :�_:_ Permit No.: -__liii; t I Department of Fire Services Occupancy and Fee Checked: �-' ''BC�AB OF FIRE PREVENTION REGULATIONS i BUILD �,�. : a Rev. 1/2023] By —''''` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL W RK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 1 2,10 City or Town of: YARMOUTH Date: To the Inspector of Wires:By this application,th undersigned ives notices of his or her intention to perform the clectrica work de cribcd below. Location(Street&Numb ): e Unit No.: Owner or Tenant: be/1f G Email:J Owner's Address: (pi/Q ( Phone No.: Is this permit in conjunctio�Aj,with pildi permit?(Check appropriate box)Yes❑ No X Permit No.: Purpose of Building: Pare 71?4'// Utility Authorization No.:'_/�jf� / -f Existing Service: a Amps 6 ).O/, - Volts Overhead Underground❑ No. of Meters: New Service: Amps 1 ge /V-4.0 Volts Overhead Underground No. of Meters: / Description of Proposed Electrical Installation: ,/e/(/ ? c; t '/ 5-pi v 7 re, • 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 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System ❑ 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❑ Level 1 ❑ Level 2 0 Level 3 0 Rating: OTHER: W Attach additional detail if desired,or as required by the Inspector of Wires. z 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-1 ❑ or C-1 ❑LIC.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: cal 4 /d (.•-'/f G 4 • LIC.No.: 3 �i ©96 Security System Business requ ! ' es a Divisi n of Occupational Licensure"S"LIC. S-LIC.No.: Address: 2-4-2-4— J �(9 4 (� Email: /4& 1/i /&ti a, dad/ 6,tO/17/ Telephone No.: 7 / ct Av 373 I certify,unde e pains m ',p Ides o erjury,that the ' o motion on Ills applicat,i n is true and coin fete. Licensee: .r rint Name: V 4�' 6 Cell.No.: r' ?)g INSURANC COVERAG . Un s waived by the owner,no permit for the perforce 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 ElSpecify: 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❑ Owner/Agent: Tel.No.: Signature: Email.: tt.�Li!'.iiV,t)NWEALTH.OF 7MASSACHUSE`iTS ra!VISION OF OCCUPATIONAL LICENSURE BOARD OF • • ELECTRICIANS ISSUES THE FOLLOWING LICENSE REG JOURNEYMAN ELECTRICIAN EDWARD M LYNCH ti y 25'WIDGEON LN WEST YARMOUTH,MA 02673-3818 C �J 35609 E 07/31/2025 377314 'A1.1.1 .14iL�il:f 11161LI L IIIselI:il_1MMd i:1 4