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RECEIVED
JUL 3t)25 J Official Use Only
Commonwealth of Massachusetts Permit 02..—(.0 ci7
BUILDINi W41 'ILNT Department of Fire Services Occupancy and Fee Checked:
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= D OF FIRE PREVENTION REGULATIONS [Rev.In023]
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/.'a/ 2 i
To the Inspector of Wires:By this application,the undersigned gives notices of h�•gyr er intention to perform the electrical work described below.
Location(Street&Number)//'V C c/o,/2C. AG,f�4S a*4cjiT,io/ Unit No.:
Owner or Tenant: Cr,/DAfoC QC/i es- Email: y
Owner's Address: Phone No,:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes IDNo 0 Permit No.:
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Purpose of Building: ' d°(-e'L Utility Authorization No.:
Existing Service: (c60, Ampg Yd/ Volts Overhead QVUnderground❑ No.of Meters: ✓
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters: /
Description of Proposed Electrical Installation:, ati Gt./s f ec e 6 c" /t� 7,7 fr3ce r'ri1/ /(-/J��
, e) ?',b07/n°/s cketkeerr7c,71'- CystCe- Ode rC/OfJ-e/r/ 3 C6e) ?4c/Lir,/�y
Completion of the following table may be waived by the Inspector of Wires. • / -7!
No.of Acceptable Outlets: 7 No.of Switches: Generator KW Rating: Type:
No.Luminaires: No. fRecessed 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.❑ Above-Grnd.0 Hot-Tub 0 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 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 0 Ground-Mount❑ Level 1❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy) •
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: Jf-/enijc-d C h/.4 a A-1❑or C-1 IC.No.:
Master/Systems Licensee: LIC.No.:/I'i❑,L
Journeyman Licensee: �c a',e • LIC.No.: ( 3 2,3 Z6
Security System Business requires a Division of Occupational LLiieensure"S"LIC. S-LIC.No.:
Address: l tf 5/ cfL yJJ/77 e A' ,&
Email: ,c4••6 e C h it_/DI 35>'AT�4 Lr c�• C6,77• Telephone No.: <5 Seel��"-�G/15
I certify,under the pains and p ralies of perjury,that the in nnatioon on this application is true and complete.
Licensee: /-/ � �i1-1 Print Name: 37(J,/'�('A,l br Cell.No.:
INSURANCEVERAGE: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 sam o 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 my signature below,I hereby waive this requirement.I am the:(Check one)Owner❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
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