HomeMy WebLinkAboutBLDE-25-1048 RE EIVE
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F 05 2O25 F
'!t!LDING Official Use Onl
yr-- __ ___-l ealth of Massachusetts Permit No.: GZ3--IIDt(t
t�^.Iil®fit Department of Fire Services Occupancy and Fee Checked:
.=:R + BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023] •
T- 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: 8-5-07.O,2 c
To the Inspector of Wires:By this a plication, undersigned gives oices of his or her intention to perform the electrical work described below.
• Lo tion(Street&Nu ber): n0/ /p )ty Unit Np�.: ))
�.rTenant: i' Email: La/1/C d rv1 / YV1Q./•"+'h't
Owner's Address: , ,A-- dj'O/Witil / /' i✓o.-nroru014 /PhoneNo.: 7R/-6/ -g-Zy3
Is this permit in conjunction with a building permit/(Check appropriate box)Yes IIo❑Permit No.:Bak-a c/•-C 7, .
Purpose of Building: P es;
.den r e Utility Authorization No.:
Existing Service: „2ev t7 Amps / Volts Overhead❑ Underground ZY No.of Meters:
New Service: Amps /_Volts verhead 0 Underground❑ No.of Meters:
Description of Proposed Electrical Installation:/1 r� / t)n D a� . Qt-tom late /c P�
C/CC Ltd ea.- 25 cL/%`e/Oace
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 0 No.of Devices:
Swimming Pool:In-Grnd.0 Above-Grad.0 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❑ Ground-Mount 0 Level I 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by die Inspector of Wires.
Estimated Value of Electrical Work: /oo. i (When required by municipal policy)
Date Work to Start: 8- - Inspections to a ested in accordance with MEC Rule 10,and upon completion.
Oty4Pt' FIRM NAME: /G/Ii'e ..--/ C4("*nZ.'i A-I❑orC-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: • LIC.No.:
Security System Business requires a Division of Occupational L'ensure"S"LIC. S-LIC.N ,:
Address: 3 n17 i�(Q c/. Q/ L� q p Lht• �� S
Email: CLvi C i/S D M /! 9d pi /CGirsTelephoneNo.: 70 7"9,2,51- 934'3
I certify,and the pa'is and a aides f ►Jury,that the Life nation on this apppll cadon i tr a and complete.
Oa .'e I.,
'iet'Licensee: rintName: /c i / L c(`4rd,,,Cell.No.: 713/ '024/ ?.?y3
— ' INSURANCE COV GE:Unless waive 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 0 BOND 0 OTHER❑ Specify:
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insuranceoverage normally
r d by law.By t signature below I her y waive tl is requirement.I am the:(Check one)Owner[Id'Owner's agent❑
Owner Agent: t r Z7 Tel.No.:p/7 /4/ !!77yy 7.'c/- /)
Signature: r,�L Email.: e /Ii r i'he /9.9ngfroaii