HomeMy WebLinkAboutBLDE-26-260 .1
MAR 0 3 2026
Commonwealth of Massachusetts o rcial u my
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_ld; ' Department of Fire Services Occupancy and Fee Checked:
m r ev. 1/2023
1_I _ BbARD"OF FIRE PR NTION REGULATIONS 1 •
•— '` 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: •S/7/2-
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): (90 /11/2 it-o 2 Alac, K Unit No.:
Owner or Tenant: -, ,✓ zu,-L/( Email:
Owner's Address: _r4 -5t ' 4 d,Ii) Y a 2/3- 1-1,- Phone No:
Is this permit in conjunction with a buildin, permit?(Check appropriate box)Yes 0 No Lermit No.:
Purpose of Building: , 13.0 ),- t,-r.,-_, r ' ) Utility Authorization No.: _45".S—D? T f-77
Existing Service: / c 0 Amps / u/�yf c Volts Overhead[a'Underground❑ No.of Meters: if
New Service: / e 0 Amps J.0/ (-1l— Unn Volts Overhead derground ElNo.of Meters: I
Description of Proposed Electrical Installation: Z c ik f�
�`P � t 2m c/C /c,/,- r r �o
,2 - C fU tr
. l i)d — rD„/�5 , z, ,,, fo 2/n )
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-Grnd.❑ Above-Grnd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ 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❑ Ground-Mount 0 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: rODU, (When required by municipal policy) •
Date Work to Start: j,/�C Inspections to be requested in accordance with MEC Rule 10,and upon completion.
• FIRM NAME: A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: .�0N-,J gort. 1° • LIC.No.: ,i ,4 03 - /
Security System Business requires a Division of Occupational Liccnsure"S"LTC. S-LIC.No.:
Address: ys' 3.X 02 a ,F x-(` 4 A iL urn.-/ /fl fa O i Fa
Email: ) u_ ��r y AC vie) 6Je 4.` I . d v77-N Telephone No.: 7c9/ '/9.c---7
1 eerie,under 14.p ins and p ;allies of perjury,that the information on this application is true and complete.
Licensee: 1 (. e / Print Name: J i-1
M7 fr— a3J/1- `C Cell.No.: 70 _? 1 /9 e-S
INSU CE OVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee
. provides p f liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof o s the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER 0 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.:
0 •NWEALTH •F -5, r1 -t
DIVISION OF OCCUPATIONAL LICENSURE
BOARD OF
ELECTRICIANS
ISSUES THE FOLLOWING LICENSE
REG JOURNEYMAN ELECTRICIAN `¢
JOHN C BURKE III o
45 DIX ROAD EXT
WOBURN,MA 01801-6104
� J
50364E 07/31/2028 80603
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER