HomeMy WebLinkAboutBLDE-25-891 eD I'd
R ` %:..a Official Use Only.
�i , --_ Commonwealth of Massachusetts ' ''.2.-----9 (
r Permit No.:
>!� • ,tnM-Nz Department of Fire Services Occupancy and Fcc Checked:
goo), =%''D OF FIRE PREVENTION REGULATIONS [Rev.t/2023]
ay ' " APPLICATION FOR PERMIT TO PERFORM ELECTRIC L W RK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 27 ,00
City or Town of:_YARMOUTH Date:
To the Inspector of Wires:By this a Ile 'n,th undcrsj�be Ives notices of his or her intention to perform the ciccui I work d scribed blow.
• Location(Street&Number): 7 Unit No.:
Owner or Tenant: /(t/fj eiv e c /MP 1' Email:
Owner's Address: a - Phone No.:
Is this permit in conjuncts with a ilding permit?(Check appropriate box)Yes b No 0 Permit No.:
Purpose of Building:conjunct,
e 4(i' Utility Authorization No.:
Existing Service: IOC' Amps/}(2/2s l'olts Overhead Underground 0 No.of Meters:
New Service: 7Q17 Amps/hp/ Volts Overhe / Underground No.o Meters:
Description of Proposed Elec ica I tallation: ee U O(/ 0
4/id r/7;ycop ec14feve 'F,,7/5 (1tCesa,` Div lv o /he
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable 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-Gmd.❑ Above-Gmd.❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System 0 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❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elecjr I Wo : (When required by municipal policy)
Date Work to Start: (tP" 2"7 z�Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-I❑or C-I❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: LIC.No.:F,-16
Security System Business requi es a Division of Octt pational Licensure"S"LIC. S-LIC.No.:
Address: .0O e .
Email: (i Telephone No.:
I certify,and a pains n nettles perjury,Mat the 1o`/nation t/his appllca/ion is true and complete.-7
Licensee:lr�{ ,i Print Name: 1� �Y/ L /C, Cell.No.:/7 ` 2O9 eiyi
INSURAN E COVER E: nless waived bythe owner,n66 04 jJ[
permit for the perfo�nance electrical work may issue urt7ess the licensee
provides proof of liability includi "completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof f me to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER❑ Specify:
OWNER'S INSURANCE AIVER: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❑
Owner/Agent: Tel.No.:
Signature: Email.: