HomeMy WebLinkAboutBLDE-25-738 Btbe ),1 --7.3
Common wealth of Massachusetts Official Use Only
Permit No.:
it:.—......._.0_ Department of Fire Services Occupancy and Fee Checked:
1I—: Y BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/2023] •
'''' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date:
To the Inspector of Wires:By this appli tion,the undersigned ives notices of his or her intention to perform the electrical work described below.
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• Location(Street&Number): .33 o f CRU Y1,6. SO. '/ATPA- Unit No.:
Owner or Tenant: t "TgiA\p(1 CS urn Email:
Owner's Address: Phone No.:
Is this permit in conjunction with a builcitn.g pc 't?(Check appropriate box)Yes N: No❑ Permit No.: v1.6—I IS
NV.of Building: "cii, - 1,C II. Utility Authorization No.:
Existing Service: l.00 Ahps JO / 40 Volts Overhead❑ Underground gi No.of Meters:
New Service: Amps / Volts Overhead❑ Underground 0 No. of Meters:
Description of Proposed Electrical Installation: ftVithCc lfeAe , er
� 61k`tTN`051i'1 R r+tOl '
Completion of the following table may be waived by the Inspector of Wires. •
No.of Receptable Outlets: / No.of Switches: 7 Generator KW Rating: Type:
No.Luminaires: No.of Recessed Luminaires: 7 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 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❑ Ground-Mount❑ Level I 0 Level 2 0 Level 3 Iii Qi1ii ' V E D
OTHER: t 1.
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Attach additional detail if desired,or as r Inspector of Wires. MAY 3 0 2025
Estimated Value of Electrical Work: 0,p00, "equired by the" (When required by unicipal policy)
Date Work to Start:frilf oVt o25 Inspections to be requested in accordance with MEC it ,I,Rg PAR Ohm.
FIRM NAME: A-1 0 or C 1'QZTC:Ifv:-: --
Master/Systems Licensee: LIC.No.:
Journeyman Licensee:l C t E' LtJ t l �/4 LIC.No.: 394.255 e.
Security Syste Business requires a Division of ecupational Liccnsure"S"LIC. S-LIC.No.:
Address: ‘0. tC> £ fl l�A T O tC)\ i
Email: 6 0.t`cjfy 3%Q QI,\A t 1 ,CO ON Telephone No.: Sit,p ` O" 47(9.. 9
I certify, a the is a r enaltles of perjury,that th infonnati a on this a plication is true and complete. j
Licensee: Print Name: (Ina. lot I y Cell.No.: Ff 36 -4163INSURANCE C VERA : Unless waived by the owner,no permit for the performanceectrical work may issue unless the licensee
provides proof of liability i uding"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 ] BOND 0 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.:
.1.,
9. COMMONWEALTH OF MASSACHUSETTS
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN 7
DANIEL O WILKEY
168 CENTER ST
SOUTH DENNIS,MA 02660-3744
32288 E 07/3112025 268634
a 10ENSE NUMBER EXPIRATION DATE SERIAL NUMBER