HomeMy WebLinkAboutBLDE-26-616 RE 1 E L 1)/J-Cr l/ if)Sarei 1/7(Z.
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APR 20"c�
Commonwealth of Massachusetts , �_'�cialhUse On ,
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Permit No.: (74,„ (o,
BUILDI 4.�—._ ,_0. Department of Fire Services Occupancy and Fee Checked:
By =�1_ �4 BOA1 D OF FIRE PREVENTION REGULATIONS [Rev. 1/2023J
` `�` 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: 2 $
To the Inspector of Wires:By this applicatio/nn,the undersi ned gives notices of his or her int ration�to�'erform the electV-27/
wscribed below.
Location(Street&Number): u 0 e.k zik,0 h,e0 ( '/7.e nit No.:
1(`(llfNu� Owner or Tenant: HKC N 1/17(Pa- G,ni Oo 5 Email:
0 Owner's Address: Ste` Phone :
04.)00A.,
�.)J Is this permit in conjunction wAth a building permit?(Check appropriate box)Yes El No Permit No.:
Purpose of Building: Clog 11. ' ' “ 6.1/00 OILS Utility Authorization No.:
Existing Service: w, Amps ) 2 /- y a Volts Overhead❑ Underground E No. of Meters:
New Service: Amps / Volts OverheadOverhead El Underground ❑ No. of Meters:
Description of Proposed Electrical Installation: ^�r11`t /PV i 7 of ci L l-t - d
9rr c.NS 6 ,c�,�r-G LSG ) . (t4 44 o/' .
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 0 No. of Devices:
No.Air Conditioners: Total Tons: Telecom System❑ 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❑ Level I ❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Elec ical ork: / �-0 0 (When required by municipal policy)
Date Work to Start: 2 i L Inspections to be requested in accordance with MEC Rule 10, and upon completion.
FIRM NAME: P ��t-rr 42-U rI pl nog- V A-I Elor C-1 ❑ LIC.No.: 33 77b-
Master/Systems Licensee: LIC. No.:
Journeyman Licensee: LIC. No.:
Security System Business requires a Division of Occupational Licensure� ns "S"LIC. ,l�S-LIC.No.:
Address: ?9- /�10yy,,��///���L0��t��'r ?O W I i wri Th Q2 C
-13
Email: 06/2i.")(1,1T�fn 06 (-2A(.12 _ 4/1--, _ Telephone No.:( !--7)'72 -Ou g
I certify, der the p ins and nalti of perjury,that the information on this application is true and complete.
Licensee: - Print Name: D0� t� c fa Cell. No. 6/7) ?7Z - 011
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 undersigned certifies that su h cov rage
is in force and has exhibited proof of s me to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ OTHER❑ Specify: SAF�'� r 3 73 27 -
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance cover ge n rurally
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.:
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