HomeMy WebLinkAboutBLDE-26-69 RECEIVED
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. , Department of Fire Services Occupancy and Fee Checked:
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BU11 . '�:_J `�'�,_*"„�' - -0F FIRE PREVENTION REGULATIONS [Rev.t/zoz31
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�Y — • ' ' (CATION 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:ja✓t• 15- 'LD 2
To the Inspector of Wires:By this application,the undersigned gives notices of;�his or her intention to perform the electrical work described below.
• O Location(Street&Number):( O , o-I 3 J
),roof.s I ✓-i V Unit No.:
Owner or Tenant:L,h,-lci S'y,.,r4(-1 <4--Li,.s k C 1-47,,t,kevEmail:
Owner's Address: Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: ( t...e`I i a Utility Authorization No.:
Existing Service: w Afitps(7,4?/Z?QVolts Overhead❑ Underground,' No.of Meters:
New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: ft.0 s'-e._ 1-1 e ,, Yee (`-cc-(-2 0".1--(2t--s
f , wl vac,I.v 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: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool:In-Grad.0 Above-Grnd.0 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 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 I 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: (When required by municipal policy)
Date Work to Start: I-l2-2„(,, Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-1❑or C-1 ID LIC.No.:
Master/Systems Licensee:-- LIC.No.: �7
Journeyman Licensee: �/c(. )5- s/q L1C.No.: `, I t�C,
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
2 Address: a 14 e-t---- Si--( Jen t 7)4.4ti kt (S t''l 4- 21 Z& 6 C.
t712 Telephone No.:`9 O B 2Z( 't)G
Email: r�r2 S Sr; r� ^'1 r,�lM�cr S f- � '(-- P �f�-J
I certify,un er the pains and penalties of perjury,that the Information on this application is true and complete. It
Licensee: _J 44 e4 Print Name: JO/al 'Z F.45sf}ti'�' Cell.No.:S0B -2-Z t -05'-(T
INSURA CE 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 o me to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER 0 Specify:
OWNER'S INSURANCE W IVER: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 otte)Owner 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: