HomeMy WebLinkAboutBLDE-25-1098 Commonwealth of Massachusetts Official Use Only
Permit No.: i- Z`» o
ti �/ Department of Fire Services Occupancy and Fee Checked:
I BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/20231
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C R 12.00
City or Town of: YARMOUTH Date: 8i 13 �.,�
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electri al work described below.
Location(Street&Number): 135 TO/4-Te_t+' 2 5ele OrtoG RD Unit No.:
Owner or Tenant: V-'eCce,p_ Ce,CTC-I(o Email:
Owner's Address: 5 0,-(' Phone No.: Len 97.S• 73c'7/
Is this permit in conjunction with a building permit?(Check appropriate box)Yes&No❑Permit No.:
Purpose of Building: Utility Authorization No.:
Existing Service: ,00 Amps t ao/ Nn Volts Overhead 0 Underground- ' No.of Meters: (
New Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
Description of Proposed Electrical Installation: IN/9ttvot..t.n Poo .Otw-o O- Ntv rPJ qR=AND
yyp3 QFybt aepor-r t NLW +-v Razd iT3 12 r cl,,Ec-r reeze.IL ((1cc..oNo�t�T
Co d* t.op_ r I
riiaonoft a ollowing oblem��ewaaiiveed ttheInspectorofWires.
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-Gmd.0 Above-Gmd.0 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❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices. ,,,,, "" • 1
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: " �/
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level I 0 Level 2❑ Level 3❑;Rating:
OTHER: i AUG 1 3 2025 ; i
,iiAttach additional detail if desired,or as required b the Inspector of Wires. L�
Estimated Value of Electrical Work: 4 Sou (When required by municipal policy) .
Date Work to Start: y tI 13(,.S Inspections to be requested in accordance with MEC Rule 10,and upon completion.
m
FIRM NAME: ILO-yonD* %A BOYAEA(2.0eL—IE A-1❑orC-1❑LIC.No.:33(v.)-1'E
Master/Systems Licensee: p LIC.No.:
Journeyman Licensee:�1�Gwlor40 W pOm�jAD-b i-ea— LIC.No.: 3 3 (i a-1 L
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: ?0 Go a-441I ' 7k w 4i2-wk.-K-t.' yc -A Scke-e-t_r WI A 0e4
aefi
Email: ("LabQVvA (rte2 3@_.twc,tf •canA Telephone No.: Sb4sr;----21{'90-g ---
I certify,u er the pains ay penalties� of perjury,that the information on this application is true nd complete.
Licensee: N land�tL '� t�'[�Print Name: R/Qyft' ra rJd tJ, : JMBAtt. _ SbS/.)-7ct eta-8-.)-
INSURANCE C VERAGE: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 same to the permit issuing office.
CHECK ONE: INSURANCE❑ BOND 0 OTHER❑ 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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: