HomeMy WebLinkAboutBLDE-26-398 rCk,A , , 1 ,
_ 1 Commonwealth of Massachusetts official Use only
4 -rl 026 of Permit No.:�(' - `��f''�
>�+ =, Department Fire Services Occupancy and Fee Checked:
pii,r, ; �, BOAI� 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: -5/16 f
To the Inspector of Wires:By this appllic�-tion,the undersigned gives not s of his or her intention to perform the electrical work described below.
Location(Street&Number): T 1 yv�w Q p 6 l' D j Unit No.:
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Owner or Tenant: c r„, Email:
Owner's Address: Sl,4(�}W'tNQ. Sc Ni6/ A- Phone No.: 'I{ "1b I ki
Is this permit in conjunction with a blinding permit?(Check appropriate box)Yes❑ No 0 Permit No.:
Purpose of Building: r S k 4 v ( Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground 0 No.of Meters:
New Service: Amps / Volts Overhead D Underground❑ No.of Meters:
Description of Proposed Electrical Installation: t< k e✓\ fi e {rnu 2e I `"A (' C c.e sS c k c v I,w 54' i
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Qu '—ft, c .6 v R l k--. Vq C ` ee_t� e\ �S(-l9� Crre...�si k,itrGioq S tAo'�rie celtc.
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-Grnd.0 Above-Grnd.0 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 ❑ 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 1 ❑ Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 3 5 6 D (When required by municipal policy)
Date Work to Start: `.. ` II aP Inspections to be requested in accordance with MEC Rule 10,and upon completion.
'FIRM NAME: - -3--\ v n i A-1 ❑or C-1 0 LIC.No.:
Master/Systems Licensee: ? u ( DV h/c-\ LIC.No.: E-5-76 I Cj
Journeyman Licensee: LIC.No.: ft t t �—S
Security System Business requires a Divisi n of Occu ational Licen re"S"LIC. S-LIC.No.:
Address: D 1 e .t l e re ee 01_1.--
Email: Gll ,) ( d v tk r\ Q 1 o cl-Y'l C1 C. LA a
i / P(1G4"kTelephone No.:7 7 Lt- 33 S' / �/
I certify,under the pains and penalties of perjury,that the-information on this application is true and complete. ( ! u
Licensee: `�W-,-s \ kti( ,v N i \ Cell.No.: 7 Print Name: 7 3>_
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 u dersignedicertifies that such coverage
is in force and.has exhibited proof of sam the permit issuing office. a ' �L;c.L k t-' c )<Q - 7-b
CHECK ONE: INSURANCE OND 0 OTHER❑ Specify: 1
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not ha e the liability insurance coverage normally
required by law.By my signature below,I hereby waive this requirement.I am the: (Check one)Owner❑ Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.: