HomeMy WebLinkAboutBLDE-25-805- Commonwealth of Massachusetts Official Use Only
_._ Permit No.:
wi Department of Fire Services Occupancy and Fee Checked:
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-'..----.:.e.--------' 14 BOARD OF FIRE PREVENTION REGULATIONS [Rev• l/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 12.00
City or Town of: YARMOUTH Date: Co ' / t '2
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
• Location(Street&Number): a O t e. t c! A ROI Unit No.:
Owner or Tenant: -3 t4Cab 1--e_ i S `- Email: ShcEuJu O -t!/d y/I P /4(400 . CQ
Owner's Address: 5p (je.i0-ev i, ( .c_k- Phone No.: SQ S--giro--` 9,
Is this permit in conjunction with a building permit?(Check appropriate box)Yes El No❑Permit No.: 4t/J
Purpose of Building: (2_e) t deftli--0 Utility Authorization No.: ,t/�s4-
Existing Service: Z t)e Amps ((a / Z Z/e Volts Overhead 21 Underground❑ No.of Meters: /'
New Service: Amps / Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: . e`cr t C_e -C dJ S P-P�-( iu
R-€ — c-0 du t,)-e(_-1--1 d nJ Q4- 4,1.e
Completion of the following table may be waived by the Inspector of Wires. •
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Tyi E D E I V E D
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rati g -' -`
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVIA: aaki. 1 2
Space Heating KW: Heating Equipment KW: No:Motors: Total HP: Tot&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/AleRirigtElikitit G DEPARTMENT
No.Oil Burners: No.Gas Burners: Video System ❑ No.of 1JIP'AY — --
No.Air Conditioners: Total Tons: Telecom System❑ No.of Outlets:
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❑ Ground-Mount 0 Level I 0 Level 2 0 Level 3 0 Rating:
OTHER: _ _
-- VISUt��- I-� Pe� �rory OF4�tt /N'G 7,(Jd K�h1P �o „.- QfU(C �_ -..-
Attach additional detail if desired,or(s requirel b the Inspector of Wires.
Estimated Value of Electrical Work: (-- i-O`)(3 (When required by municipal policy)
Date Work to Start: 6 - 1 1 . 2. Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 0- o.�..s i- 0 Q 9-1.e/3 A-1 ❑or C-1 ❑LIC.No.: 117 V
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: - jc5S 3 0 8 g(0 l3 • LIC.No.: r 3 I C17.
Security System Business requires a Division of Occupational Liccnsure"S"LIC. S-LIC.No.:
Address: (. t/.3 (y1a(t^) S 4- CE--cir + (Wd 62 tee
Email: S44(t)N OrR-(c2,t) t f/ e y't- t-6=30 - O ctA • Telephone No.:re&- 8v (CE7-.?
I certify,under the pains and penalties of perjury,that the information on this application is true and complete,
Licensee: et v.. Print Name:\5---h ((UV O of 4-af) Cell.No.50 -510--5)i,3
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance 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 same to the permit issuing office.
CHECK ONE: INSURANCE 0 BOND❑ OTHER❑ Specify:
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law.B my signature below,'!hereby waive this requirement.I am the:(Check one)Owner 10 Owner's agent El
Owner/Agent: G,& - e( S 7 Tel.No.:5-0 b-' ' `..513
Signature: Email.: $' cue O rLed.ql 1 @ t fitgfie .ce0
I'' COMMONWEALTH OF MASSACHUSETTS
DiVI .-" 'OF OC t':ATIONAL LICENSURE
BOARD OF
ELECTR AANS
ISSUES THE FOLLOWING LICENSE
AEG JOURNEYMAN ELECTRICIAN fx
SHAWN E OBRIEN
1243 MAIN ST.
COTUI T,NIA 02635 w
2387S1
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