HomeMy WebLinkAboutBLDE-25-925 Commonwealth of Massachusetts Official Use my
1_Ylil e Permit No.: /J�—$75
�' Department of Fire Services Occupancy and Fee Checked:
wr2.e� + BOARD OF FIRE PREVENTION REGULATIONS [Rev.12023] •
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: 7/i d/2
To the Inspector of Wires:By this applied'n,}he undersigneda gives notices of h orr her intention to perform the electrical work described below.
' Location(Street&Number): i O {�U.O ROC(C /S'J Unit No.:
Owner or Tenant: f f e-11 r i/ � TO 1? .4-f1J ,.i Email: Yt e i1 f V J o r/u s/' ,5-/�ji 1rtr t.i.
Owner's Address: ( Phone No.: ..e6
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Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No 1rmit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: / 5 C Amps /2.0/.24evolts Overhead nderground❑ No.of Meters: I
New Service: Amps /_Volts Overhead❑ Underground❑ No.of Meters:_
Description of yroposed Electrical Installation: c /' e-P L 4-C,t' I/U 4-C /9-.D L /2)P c,/
r!e ✓Z Co N 0 6 /O/V I /l '
Completion of the fallowing 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:
pace Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
z o.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
u
w imming Pool:In-Grnd.❑ Above-Grnd.0 Hot-Tub ElNo.of Self-Contained Detection/Alerting Devices:
r� 5
est'^ o.Oil Burners: No.Gas Burners: Video System 0 No.of Devices:
N A 4) .Air Conditioners: / Total Tons: , , tS Telecom System❑ No.of Outlets:
r� .Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices:
rl.l-\: tar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply
PP Y
.� J a of Modules: Roof-Mount 0 Ground-Mount❑ Level I 0 Level 2❑ Level 3 0 Rating:
1J '' �_ 'HER:
or
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Elecgical Work: (When required by municipal policy) •
Date Work to Start: 7 /7/Z S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: 4e.,yl✓'.( f J O/Z 6, Ji ^i ✓'Z LIC.No.: Z y y 3 y-&-
Security System Business requires a Division of Occupational Licensure"S"L1C. S-LIC.No.:
Address: 5-C7 18 Lc, e- Zoe IC a s yfekno 0Ti - /nA o z66y
Email: Telephone No.: 50 F-"737 —`?467 -?
I certify,and the painse lites of perjury,that the information on this application is true and complete.
' Licensee:, -Al�/ ero A Print Name: l'fed,�y trJ 1/2 ).4,sr.j3�ell.No.: 0g-737-f4�y
INSU E CQ""yy�r GE:Unless waived by the owner,no permit foithe 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 0 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 f y ig a to I hereby waive this requirement.I am the:(Check one)Owner O�Owner's agent 0
Owner/Agent ,f1.4. fit Tel.No.: • /�
Signature: /J „C [� /` Email.:/1 01 ,t J��/-rV jai f C-t0