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SgnIrVaalth of Massachusetts Ocial Use Only
Permit No.: 'ZS— (2./..5
c17j { Department of Fire Services Occupancy and Fee Checked:
i3OARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: YARMOUTH Date: y�JrJ%1
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the cloctn nl watfr described below.
Location(Street&Number): 4,$ /3i400atId/LL. AAAIE Unit No.:
Owner or Tenant: Alit j Ac Email:
Owner's Address: Phone No.: 5ps-3 4 4-4tr4-4
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: '7fle'S!DE.v7%il L Utility Authorization No.: 2 2&O 4-k y e
Existing Service: /D O Amps/2a/2/4Volts Overhead("Underground❑ No.of Meters:
New Service: p O Amps/24?/..21D Volts Overhead[9'Underground D No.of Meters: I
Description of Proposed Electrical Installation: -C,ust:A L t1Fu/2.o q DvE b SEt2Vtct' 4.
lJwce S'a;;wider ¢4ovt4FAA's.
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: Na:Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool:to-Gmd.❑ Above-Grnd.❑ Hot-Tub❑ 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 0 Level I 0 Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: 9 %7/7(' Inspections to be requested in accordance wills MEC Rule 10,and upon completion.
FIRM NAME: c-,er"A. ` •ARRe/,ea .&'e7ie A-1❑orC-1❑LIC.No.:C/9g6/
Master/Systems Licensee: n LIC.No.:
Journeyman Licensee: /7 0 BERG' At=pRRe`I Rc LIC.No.: Z/90f I
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: /O.n ,9Oy /67G �. eKou�/FrMA 0244 7
Email: CA kW a'/Ro + .tit=uRtei@ 5/A hoc,aCori'. Telephone No.: O� PO-DS3r/
I certify,under the pains and penalties s of perjury,that the information on this ap cation is true and complete.
Licensee: �oi? � ___ Print Name: n QF1'i,f t"�AFPc1;4i Cell.No.:s'ea_J.Sp-co53'J
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 f same to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER❑ Specify:
OWNER'S INSURANCE WAIVER:I am aware that the Licensee dots 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.: