HomeMy WebLinkAboutBLDE-25-981 RECEIVED
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. C� mmonwealth of Massachusetts �.Z�
z�25 Permit No.:
tiri :t . Department of Fire Services Occupancy and Fee Checked:
su; /! DD pF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
`__aBy ''' 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: 11/C)7/a5
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): V�.t 1 -)-t . Unit No.:
Owner or Tenant: N au V y h e(-rod S I.i nf\e,r Email:5 hecroci,05K;me 3 m&) w I,CAM
Owner's Address: 'Q �c�t
C y` 51. e Phone No.: (17 a— I-011,0
Is this permit in conjunction with a building permit?(Check appropriate box)Yeset, No f Permit No.:
Purpose of Building: ..DWELL v Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: c re. ne A) add i-1 on Gn d
r►t 0. Pump
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: 1 n No.of Switches: 6 Generator KW Rating: Type:
No.Luminaires: 6 No.of Recessed Luminaires: i 6 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: 1 Total KW: 6 Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grad.El Above-Gmd.El Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System El No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ 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 El Ground-Mount 0 Level 1 ❑ Level 2 El Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 8,OOi,co (When required by municipal policy)
Date Work to Start:' 1110 7/Q5 Inspections to be requested in accordance with MEC Rule 10,and upon completion./
FIRM NAME: 16(ALt,�C. , eeC L1 Inc. `, A-110orC-1��❑LIC.No.: gopA -
Master/Systems Licensee: hs C k.a.cJ C e.IEr.t�� LIC.No.: o�o�I S(-I A
Journeyman Licensee: )U(it 6 C K1l#kC, w LIC.No.ir I
Security System Busin/
requires a Division of Occupational Licensure� "S"/LIC.I (fin Sp-LIC.No.: r
Address: �b DrI V t F�ly�QV iv\ M A Q c36()
Email: DC_k-e,lecj"rlc Jy(h,V[o,LON Telephone No.: b17 I3q`5 L5
1 certify,under t pai and enal 'e perju that the informationon this application istrue and complete.
Licensee: mt Name: (SOU OCAS C Cn, J�(1 . Cell.No.: 617—t'I S g.-5 ctLi 5
INS . nless w i e y 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 gr BOND❑ OTHER❑ Specify: Vf l(A NCB ionu 50.193
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 0 Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.:__
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