HomeMy WebLinkAboutBLDE-25-1270 ' RECEIVE
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_ _ Commonwealth of Massachusetts Official Usc Only
Permit No.: C i r-(-4 7 cm
-W.ire�r I,' Department of Fire Services Occupancy and Fee Checked:
.11 BARD 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), 27 1.2,00
City or Town of: YARMOUTH Date: /�•d
To the Inspector of Wires:By this application,the�uun��d�e`rsign d gives notices of his or her intention to perform the electrical work described below.
• Location(Street Bt N ber): lY I NUI Unit No.:
Owner or Tenant: V1 al Email: P3 MAILS fie ,/4/1
Owner's Address: fJ$' SurYl//1 e1 , c in . olSD3 PhoneNo.:
Is this permit in conjunct,io�ni+'ith a bust g permit?(Check appropriate box)Yes El No 0 Permit No.:
Purpose of Building: nf/�/it/ /�>< Utility Authorization Nol( 0,/EyBS
Existing Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:_
New Service: Amps,/ /VoltsOverhead 0 Underground //����No.of MCeters: /
Description of Proposed Electrical Installation: e�x� ti 2t'- '�Ce.4),441t_- J ,�.{,i.t f+
•
Completion of the following table may be waived by the Inspector of Wires. ������� .
No.of Receptabie Outlets:/6, No.of Switches: Generator KW Rating: Type:`d L 7r�''�"�
No.Luminaires: No.of Recessed Luminaires: p 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: �q No.Gas Burners: / Video System 0 No.of Devices:
No.Air Conditioners:j2 Total Tons:(a 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: �n
No.of Modules: Roof-Mount ID Ground-Mount0 Level I❑ Level 2❑ Level 3;, Rating:6e)/9
OTHER:
Attach additional detail if desired,or as 4Pired by Olekspector of Wires.
Estimated Value of Elefr Work: 2/ G(u (When required by municipal policy) •
Date Work to St/a �7 sec'ons to be requested in accordance with MEC Rule 10,and upon completion.
• FIRM NAME:( �/d „ A-1 0 or C-11 0 LIC.No.:
Master/Systems f7ceensee: 0 LIC.No.: /y/cZ547
Journeyman Licensee: >v LIC.No.:aq 9/36
Security System Business requires a Division of Occupational Licensure"S" S-LIC.No.:
Address: it2 5(I m.ne4 /21/ J Ji//mil , ' a 3 q 1 /
Email: 1/,T}}?/�/(cSh19/I r /0,CA'.. ' TelephoneNo.:5o 9? a:63
I certify,un the ahrs a d pe lti of erfury,that the information on
this a cart pn•ne and complete.
/od� �
Licensee: Print Name: /GLIIO/2ll c �G{2/rw� Cell.No.: .Y.. . 3
INS E COVE GE:Unless waived by the owner,no permit for the o tine 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 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: Tel.No.:
Signature: Email.: