HomeMy WebLinkAboutBLDE-25-1501 LRFICEWED
NOIf�,5 2025 Commonwealth of Massachusetts Official Usc Only j
_J Permit No.: tJ l,I)t-A 5 /s O
BU `Dr�-IJT Department of Fire Services Occupancy and Fee Checked:
3} . .'i",3+_BOARD 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 M? 12.00
City or Ton of: YARMOUTH Date: i /Z�
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To lice Inspector of Wires:By this application,the undersign id gives notices of his elm intention to perform the electrical work described below.
Location(Street&Number): t Cj cy p-01,✓•. ot L 0 v\ f(1 1 Unit No.:
Owner or Tenant: JP4h I Jo'h rae rt-g_ Email:
Owner's Address: Phone No.:
Is this permit in conjunction/ with a building permit?(Check appropriate box)Yes 0 No 0 Permit No.:
Purpose of Building: ri 0 In S C Utility Authorization No.:
Existing Service: /---0 0 Amps 4.1 m/'hrl 0 Volts Overhead 0 Underground❑ No.of Meters: 1
New Service: Amps / Volts overhead❑ Underg ound❑ No.of Meters: y
Deser�tion of Proposed Electrical Installation: r r P e�l 0\A 4 1 IN t Y i Vi pl t�1 b e cwt e r`
A,O km ,-,1 I?, k i,pe(Ili;ire- >-it ,
Completion of the following table may be waived 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 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 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❑ Level 1 0 Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desiredd,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: /C.260.I.0 (When required by municipal policy)
Date Work to Start:/by//N/ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 'e-ti 6 .Ac "v E'lecrriC A-1❑orC-I❑LIC.No.:
Master/Systems Licensee: 1/ LIC.No.:
Journeyman Licensee: PP-1 � �?o rDfo 1/1, LIC.No.: 55-e30'g
Security System Business requires a Division of O pational Licensure"S"LIC. S-LIC.No.:
Address: yty'� l'.G//�_�S I9✓9 ✓f -r6C�-4f-)-4 2 /-1 1 5 //� ,(
Email:jY101[/:6,GO r'f�l^� to ro.at I . c>�'- Telephone No.: �C/ O 75 e e O7 7
I certify,under the pains and penalties perjury,that the Information on this applicatipu is true and complete. p
Licensee: i d Print Name: /mil A o C 7:3'✓t Cell.No.::O e6- ''v77'
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 of same to the permit issuing office.
CHECK ONE: INSURANCE -BOND 0 OTHER❑ Specify:
OWNER'S INSURANCE WADER: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 odic)Owner 0 Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.:
4114
OM ONW ` LTH OF y •ACH 'S TT .
COVI$ION OF PROFESSIONAL LIGENSUR
B,,.,rARD
ELECTRICIANS
THE FOLLOWING LICENSE
ISSUES
REG , OURNEYIItAN-.gLECTRICIAN
MATTHEW GORDON `
22A STATION AVE
SOUTH YARMOUTH, MA 02664
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Q7/31/2025 677456
55830 B -: 7:'ATE SERIAL E 3 =ER -41
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