HomeMy WebLinkAboutUntitled RECEIVED
JUN 13 2025 —3\ if.,vcAA ce Act.V
3 Official Use O y
___... _. _ i Commonwealth of Massachusetts Permit No.:
BUILDI "n_=`;:0i , �i MINT
.Mil,;..j Department of Fire Services Occupancy and Fee Checked:
=-'11 Y BO7 D OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] •
'`''• 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 application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): Unit No.:
Owner or Tenant: a_ ceV C t Email:
Owner's Address: C rx VL OL A_ Phone No.: 4(r7 78 1 (S 7
Is this permit in conjunction with a uilding permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: C 5(� o vt, t e. Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground 0 No.of Me rs:
Description of Proposed Electrical Installlation: C Q n,
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 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 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elec real Work/• (When required by municipal policy)
Date Work to Start: . C1914 r(C*e d Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 4,2 t// ./ 2l'i 0 A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.: j ? 20 (
Journeyman Licensee: • LIC.No.: A- (.l8)-
Security System Business requires a ivision of ccupational Licen re"S"LIC. S-LIC.No.:
Address: C o 1 �� 1^A.vU ‘Q,a
Email: ...A .7vt to.R 1 c:, fr at i Telephone No.: `."77 _( .) jg I I t f
I certify,under the pail DU
penalties of perjury,that Else 'n station o:this lication is true and complete.
V Licensee: V/ - el 1" Print Name: Cell.No.:77.1 nq 1 q I*
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 sVch coverage
is in force and has exhibited proof of same to the permit issuing office. CJ. /
CHECK ONE: INSURANCE[ 4OND❑ OTHER❑ Specify: Ql'j Q y� 4l'It 1 '-I17` 6'.'°' 5'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havdthe 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.:
2 e G (c�a✓� Met 1 1 t (_9 V✓l
a: COMM NNO
DIVISIO OCCUPATIONAL LICENSURE
BOARD OF er
ELECTRICIANS 4
ISSUES THE FOLLOWING LICENSEil
REGISTERED MASTER ELECTRICIAN
t\ !1
PAULM DUNN N
358 OLD PLYMOUTH RD W
SAGAMORE BCH,MA 02562-2307 J
15825 A
0713112025 339044
.::.,;SERIAL NUMBER.
LICENSE NUMBER EXPIRATION DATE