HomeMy WebLinkAboutBLDE-25-899 (2) Commonwealth of Massachusetts Permit No.: (%e7S-ly8i,
'�tli .� Department of Fire Services Occupancy and Fee Checked:
-.=1IQ' 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).427 C` 1 .QO s,
City or Town of: YARMOUTH_ Date: -7i
To the Inspector of Wires:By this application,the undersigned gives of his or her intention to perform the electrical work described below.
Location(Street&Number): 2(Q 5(n00...ie t:41.- P..) Unit No.:
Owner or Tenant: - V, P 0 0,*l2 \/ Email:
Owner's Address: (.0 5 h c70--e D/) /r Phone No.: g(o o Ti 117 7/9
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No wyermit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: / p!7 Amps 190/a.94/olts Overhead Underground❑ No.of Meters: /
New Service: /00 Amps/20/.2°/OVolts Overhead Underground 0 No.of Meters: I
. Description of Proposed Electrical Installation: R-t P�A GP 'r Xt Z i i ti g i ao.4 S�e,2.y/ t G� W i✓Lyef.,r
eTL e 2 J2-e.teat ptrr ,�J el- o s l 4-P i oL0 PNir l 1 iV l (P- 1
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Com etio o ite fol ing table may be wa ed he/ns etor df 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 0 No.of Devices:
Swimming Pool:In-Grad.0 Above-Gant.❑ 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 Device':R E C E I V E D
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: /J —
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level I❑ Level 2❑ Level 3 0 Rating: off— 7 G
OTHER: JUL 01 202i
Attach additional detail if desired,or as re uired by the Inspector of Wires. BUILDING TM E NT
By.
Estimated Value of Electrical Work:V ji 00,o(] (When required by municipal policy)
Date Work to Start: 1 A(3,S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: (2 A 1 Vyl Qi-'i) v.) 0,-)4 0 A-1 j-)t.._ A-1❑or C-1❑LIC.No.:
Master/Systems Licensee: a LIC.No.:
Journeyman Licensee: .(C�S��1.1'y��yvi.Di.) l?)o-Wt 60 tom_ LIC.No.: 3'3(,.. ..1 "E
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
`Address: C� ( O >t a-L/q zj 1W.1 s 6 'C wv i4 , o r--(a Li- -']
Email: r t✓ro O w.bot rj i CiI 3 1,(‘a 1(•CM Telephone No.: 4b�o',>--744�l g-d,
I certify,a der the p ''� andf� penalties of perjury,I that the information on this application is true and complete.
• Licensee:P '"'l✓ori nt Name: 1`4f ill�1�9 IN 6c1Y16 4610e„t SOS �,7`(ey.,3g-,
INSURANCE OVERAGE: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❑ BOND❑ 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.: