HomeMy WebLinkAboutE-25-1268 Commonwealth of Massachusetts Official Use Only
-_- Permit No.: ( --\21.,„„g
nl ./ Department of Fire Services Occupancy and Fee Checked:
t;1 BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/20231
APPLICATION FOR PER
MIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 R 0
City or Town of: YARMOUTH Date: y A 5
To the Inspector of Wires:By thus ti the de i d giv notices of his or her intention to perform the electrical work described below
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Location(Street&Number): J UC°j Unit No.:
Owner or Tenant: sod Q t G / Email:
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Owner's Address: Phone No.: /7�;b-ray Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No ]Permit No.:
Purpose of Building: U lity Authorization No.:
Existing Service: /00 Amps/X /acid Volts Overhead Underground gro 0 No.of Meters: /
New Service: (00 Amps IX / 4/o Volts Overhead Underground El No.of Meters:
Description of Proposed Electrical Installation: e t,; ' Ser�
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating:
Typ
No.
No.Luminaires: No.of Recessed Luminaires: Rating:
Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: TotalKVA:
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-Grnd.0 Above-Grad.0 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❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: SecuritySystem
g g y ❑ 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 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Ins ector of Wires.
Estimated Value of Ele��W (When required by municipal policy)
Date Work to Start: f07 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME:
A-I❑or C-1 El LIC.No.:
Master/Systems Licensee:e Se
L LIC.No.: q Journeyman Licensee: J L/fj2C, :77 ,JCS LIC.No.:J36 i 3If
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Security System Bus requires a Division of p Licensure"S"LIC.C. S-LIC.Non.:
Address: : -1-//1I '/V A 4 :yofe 62673
Email: 17SS li 7/f� /,e, !t' 6-0,44 /Telephone No.: 5 ' dr-c7
I certify,under the p and enaities of perjury,that the Info on this a
��a/��� l.p �J pp'!�,a/1i'o!n iv true and comp�ire�ttry� //l
Licensee: c,tal / Print Name: ^yL /(7Y %, P l/7/ Cell.No.:,5IT 7/v/t7
INSURAN RAGE: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 cov ge
is in force and has exhibited proof of a to the permit issuing office.
CHECK ONE: INSURANCEABOND 0 OTHER 0 Specify:L)7f/ lee `(/5 /� )6
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance cov normally
required by law.By my signature below,I hereby waive thJsrequirempnt,I ant the:(Check one)Owner 0 Owner's agent 0
Owner/Agent: 5 L= 'i Tel.No.:
Signature: i Email.:
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