HomeMy WebLinkAboutBLDE-25-1367 14 Commonwealth of Massachusetts Official Use On] 7
I. Permit No.: . -(
WI l Department of Fire Services Occupancy and Fee Checked:
to- li BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023]
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: --///o S
To the Inspector of Wires:By this applic Lion,the undersigned gives notices of his or her intention to perform the electrical wo described below.
Location(Street&Number): 117 Unit No.: 117C ///���1
Owner or Tenant: yACk7UT�1 r/ C Fr°J11_ R 1 M I Email:/vtq(r€iji tCC/p(7016, (�/c8']Al/•C
Owner's Address: Phone No.: '7 7 c7 a 7 of
Is this permit in conjunction w th a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: 1 Utility Authorization No.:
Existing Servicea?&L, Amps/io / a t//,Volts Overhead 0 Underground IY No.of Meters
New Service: Amps / Volts Overhead 0 Underground❑ No.of c-/Meters:
Description of Proposed Electrical Installation: —rQM/O (�oc4.4_ 'I - /'_ 1 i"I
l Mf o f'nn�AN/7 in Al r',✓-- ,. 1 ♦owre l7/ -i/-A 1 / 9,1H/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 0 No.of Devices:
Swimming Pool:In-Gmd.0 Above-Gmd.❑ 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 0 Level 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: QI (When required by municipal policy)
Date Work to Start: /O//6/a f �Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: .�'3CF /Y(AC A/7/'C/ A-1 0 or C-1❑LIC.No.:
Master/Systems Licensee: ^// /— LIC.No.:
Journeyman Licensee:-TL� Se. l' r/,9C,< A/2/ei LIC.No.: /E/I/ ^ iS
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:Address: % 8/120A1 //),&e, S• yite-447-1-- Aim- OAD/9/�
e I
Email: /Yin('treAIZ/P c IP ('7 /G 6 641A//`'/'eTelephoneNo.: 77t/MS )77I
I certify,under pains and pen/ s of perjury,that the information on this application is true and complete.
Licensee: int Name: - S1L M A(6e,c12-I Cell.No.:77 y 7 q I
INSURAN OVERAGE:Unl s waived by the owner,no permit for the performance of electrical work may issue unless the licensee
provides pr f liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force d has exhibited proof of same to the permit issuing ff .
CHECK ONE: INSURANCE 0 BOND 0 OTHER Specify:
OWNER'S INSURANCE WAIVER: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 one)Owner 0 Owner's agent❑
Owner/Agent: Algrat-T4 <on Sr dP fs r v/j Tel.No.:
Email.:
Signature:
f WC/1/1-e(t
‘• "
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF OCCUPATIONAL UCENSURE
BOARD' c-
E4ECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN
JESSE J MACKENZIE JR
*4.
10 BYRON LN
S YAR#419141.1, MA 026644156
• .
13111 B 07/31/2025 337613 '•
, LICENSE NUMBER EX- PIRATION DATE ...SERIAL NUMBER )
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