HomeMy WebLinkAboutE-25-1266 Commonwealth of Massachusetts Official Use On1
Permit No.: �"ZS'—( CW.CD
�' Department of Fire Services Occupancy and Fee Checked:
I BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/2023]
. "° ' APPLICATION FOR PE
RMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 1 00
City or Town of: YARMOUTH Date: / / j 9
To the Inspector of Wires:By this app icatio the andcrsi 'ves polices of his or her intention to perform the electrical orb described below.
Location(Street&Number): / Unit No.:
Owner or Tenant: ��lee Cr-el /(1)1 Email:
Owner's Address: ifieft 9 (7/1l,t5t1(Li e TP65"F0I Ph n No.: 6/7— D�9f�Is this permit in conjunction with a building perrhit?(Check appropriate box)Yes El Permit No.:
Purpose of Building: ility Authorization No.:
Existing Service: Amps/,ZO/ 0 Volts Overhead Underground El No.of Meters:
New Service: y Amps/.Z6 / Volts Overhead Undergro d
�+ 0 No.of Meters:
Description of Proposed Electrical Installafon: e
tt , .> e /
Completion of the foll ing table may be we'ed by the Inspector of Wires.
No.of Acceptable 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❑ No.of Devices:
Swimming Pool:In-Grad.0 Above-Grad.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System Y 0 No.of Devices:
No.Air Conditioners: Total Tons: Telecom System Y 0 No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: SecuritySystem y stem
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 0 Level I 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach dtBanal decall if desired,or as required by the Inspector of Wires.
Estimated Value of El/ 7c:
Yf (When required by municipal policy)
Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
A-1 0 or C-1 0 LIC.No.:
Master/Systems Licensee: ,,,/// A7,...stLIC.No.:Journeyman Licensee: /(ey '/, LIC.No.: ('p7��
Security System Business requires a/Divviisioon/ of//,/t tional Licensure"S""�LIC.[� �J�S-LIC.Nfo/:'
Address: 5 /`l/l/� % t i y1/`/ K'1/// Nil _D&71
Email: Telephone No.: .6—
I certify,under the ' and penalties of perjury,that the infornmpt on this applic true and complete. ''77 Licensee: / Print Name: :c trile>/I t Cell.No.: 7/0- 6
INSURAN C GE:Unless waived by the owner,no permit for the performance of electrical work may i e unless the licensee
provides prop of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such cov ge
is in force and has exhibited proof a to the permit issuing office.
CHECK ONE: INSURANCE Q[j BOND❑ OTHER❑ Specify:(d144/6 C9/C'(�,'73-D /f�6
OWNER'S INSURANCE A ER:I am aware that the Licensee sloes 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 0
Owner/Agent: 1 - Tel.No.:
Signature: SFP 1 R3