HomeMy WebLinkAboutE-25-1267 — - Commonwealth of Massachusetts Official Use Only
e= =:/ Permit No.: C-�LS`-(Z[o7
e_ Department of Fire Services Occupancy and Fee Checked:
[ BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023]
APPLICATION FOR PE
RMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 C R
12
City or Town of: YARMOUTH Date: ,i
To the Inspector of Wires:By this app'cat�de''vied IT 'ors o h' or her intention to perform the electricat'work bed below.
Location(Street&NA j.er): 7 / //�{��'�/ f Unit No.:
Owner or Tenant: - r ir i / e Email:
Owner's Address: Phone No.: !1 j—55/f
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No,Permit No.:
Purpose of Building: U ility Authorization No.:
Existing Service: /0[') Amps/2) /.Zy7 Volts Overhead./Underground❑ No.of Meters:
New Service: /DO Amps/iO / 0 Volts Overhead Underground❑ No.of Meters: I
. I Description of Proposed Electrical Installation:: ` 5 s /t - / i f 0 ri
t !v ./ d C ,('C <
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❑ No.of Devices:
Swimming Pool:In-Grad.0 Above-Grad.❑ 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 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 0 Level I 0 Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the of Wires.
Estimated Value of Electrcrric Wollc: (When required by municipal policy)
Date Work to Start: 7)11'c" Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
A-I❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: SeYY,le y FtA5.5 LIC.No.: 36//p
3e
Security System Business requ a Division of Occupationnaall/LLiiccens�urrree""S"LIC. S-LIC.No.:
Address: Sl/�/! � 't I%'art v JJ4 J 7
Email: � / /� `� t`��/ Telephone No.: �(/ � 0 %p
/certify,under do p ns and pens • o perjury,that the info on this application is true and complete y�[
' Licensee: /r i Print Name: •r/feI�(Q"" Cell.No.: 7X—j(j�(j/-
INSURAN Q AGE:Unless waived by the owner,no permit for the pe orm ce of electrical work may issue unless the licensee provides prop of liabilityincluding"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of e to the permit issuing office.
CHECK ONE: INSURANCE BOND ElOTHER ElSpecify:��ll1%lfrifkri w 42f /fi
-„
OWNER'S INSURANCE W gin
I amn-awaee_.that-the Licensee does not have the liability insurance coverage n rurally
required bylaw.Bymysignature below,I h ai 9 gn hereby waive this requirenenL?am the:(Check one)Owner❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: 1 REP 19 2025 j Email.:
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