HomeMy WebLinkAboutE-25-1264 +_A)t1\ evY \\ \\nSUFanC.e RECEIVED
SEP 16 2025
Commonwealth of Ma•s r r -s rcial Use Onl
t� Permit No.: ZS—1 'f
N7��� BUII-DING DEPARTML T
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�' Department of Fire ertrfces O•upancy and Fcc Chcekcd:
C.`----"e= + BOARD OF FIRE PREVENTION REGULATION ev.t/20231 •
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),57 ChfR .00
City or Town of: YARMOUTH Date: Of i/F /2-
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): S a 5 o 44 5,"4 4 1i47— Unit No.:
Owner or Tenant: M a t 4 yy el-/°a K I& G-G 1✓.' v7 Email:
Owner's Address: 3 ct ra•( - Phone No.: -2O7 r'1/G 303 do
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No 0 Permit No.:
Purpose of Building: R es;d et„C v Utility Authorization No.:
Existing Service: 20 d Amps A ie/)2G Volts Overhead[, Underground❑ No.of Meters: f
New Service: Amps / Volts Overhead ElUnderground ElNo.of Meters:_
Description of Proposed Electrical Installation: i p+ C(bo-VQ_ gQrYQie tC.`-I--/ Pc,I-
Completion of the following table may be waived by the Inspector of Wires.
No.ofReceptable 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-Grad.0 Above-Grnd.❑ 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❑ 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 I 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by tire Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start:4 I IQ i Af Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: l7c.(t k/.�, t1 A-I❑or C-I 0 LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: . 016 gTt/Q lc_h LIC.No.: 6-7.5q d if t 2-59$O
Security System Business cores a Division of Occupational Licensure"S"LIC., S-LIC.No.:
Address: R 5.' requires
i,-I tA vy � )� R c+'o a d ee'lae>* r L
Email: it 1 c l-rdt?frt. S el"Pilot•'/ Telephone No.: .3?t .g 26
I cert(J under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee:)&,lt PV--/-Ai Print Name: Cell.No.:' ')6f' 7if(c.-.)4.Z
INSURANCE COVERAGE: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 ortte to the permit issuing office.
CHECK ONE: INSURANCE UI 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.: