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HomeMy WebLinkAboutBLDE-25-787 C-,1)L----e; ---7&? Commonwealth of Massachusetts Official Use Only Permit No.: 1,417. Department of Fire Services Occupancy and Fee Checked: -11"� " BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/2023i APPLICATION FOR PERMIT TO PERFORM ELECTRIC L ORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 MR 20 City or Town of: YARMOUTH • Date: O. To the Inspector of Wires:By this applicatio he undcrsi ned gives notico.of his Dryer intention to perform the electric work scribed below. ' Location(Street&N ber): I ct�' © /� / Oq'o Unit No.: Owner or Tenant: i (,/ '01 Email: C Owner's Address: 5 g40j e• I Phone No.: Is this permit in conjunction,,,with a bpild ng permit?(Check appropriate box)Yes El No ❑ Permit No.: Purpose of Building: l �f U kve / 1,9 Utili uthorization No.: ���\ Existing Service: Amps 11 , V 1 a Yolts Overhead Underground❑ No.of Meters: •V" New Service: Amps / Vo is Overhea 0 Underground❑ No.of M ters: C Description of Proposed Electrical In tallation: G I.w / or . a -atic(ci q flqiiie q folis r2 , c , 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 V I . Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Tool C E I V E Q 0 No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices: Swimming Pool:In-Grad.❑ Above-Grnd. ❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting D4vifclets: 0 2025 '� No.Oil Burners: No.Gas Burners: Video System 0 No.ofDc‘ices: 1111�� L LJ No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlrry No.EnergyStorage Systems: KWH Storage Rating: Security System 0 No.ofDpant�t' UtYAK I MtN I y Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equill cent. i `�� No.of Modules: Roof-Mount 0 Ground-Mount 0 Level I 0 Level 2 0 Level 3 ❑ Rating: OTHER: corC tzzce_Cg%?Ie cilg//�al_e aili-/N1P_Zs _afl _1YArr ® Attach additional detail if desired,or as required by the Inspector of Wires. g 0 t/d j7q'd c © Estimated Value of Ele cal ork: (When required by municipal policy) t- 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.: a J Master/Systems Licensee: LIC.No.: Journeyman Licensee: Palljrd £,-74 C If • LIC.No.: 7 c6c9 f----' Security System Business requires a Division f Occupational Licensurc"S"LIC. S-L .No.: q' I. Address: V" IL// eo g l e. /Reny ��� Q(r ' t��b 3 �, Email: , �• /Telephone No.: ,'.3 h I certify,undo he pain n nalti of perjury,that the ' motion t tis applicati n is true and cone tete. , 1 Licensee: � Print Name: a ' • c Cell.No.: '' 972 g INSURAN E COVERA E: nless waived by the owner,no permit for the perfor once 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 of pine to the permit issuing office. CHECK ONE: INSURANCE BOND❑ 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 0 Owner's agent El Owner/Agent: Tel.No.: Signature: Email.: •'VISION OF OCCUPATIONAL LICENSUREy BOARD OF ELECTRICIANS v `� ISSUES THE FOLLOWING LICENSE REG JOURNEYMAN ELECTRICIAN EDWARD M LYNCH 25 WIDGEON LN WEST YARMOUTH,MA 02673-3818 y V 35609 E � J 07/31/2025 377314 CENSE NUMBER EXPIRATION DATE '"' SERIAL NUMBER