HomeMy WebLinkAboutBLDE-26-631 _ Commonwealth of Massachusetts 0 metal UscOnly/
Permit No:
8'�.uy�' Department of Fire Services Occupancy and Fee Checked:
t=1l=% BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023J
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL,VIORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 12. 0
City or Town of: YARMOUTH Date:
To fire Inspector of Wires:By thi p 'c ion,the undersi nod giv notices of his or her i ntion to perform the electrical work described below.
Location(Street&Nugtber): at L [ Unit No.:
Owner or Tenant: / p t4/'/ Email:
Owner's Address: /ye Phone No.: WY-7/1/4777
Is this permit in conjunction with a building permit?(Check appropriate box)Yes 0 No ArPermit No.:
Purpose of Building: Utility Authorization No.:/6 62.0.0
Existing Service: Amps fiL_/ Volts Overhead Underground 0 No.of Meters:
New Service: { Amps PP 12/�O/Volts OverheadOv El Underground No.of Meters:_�
Description of Proposed Eleptrical Installation: �/v5 /( keg) l !✓,/a�e/It drf/5'eil!/Ye
�YC4/, /mil c`,t�e °it 5&Krau5 4//l> tali APoq(f
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-Grad.❑ Above-Grad.❑ 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❑ Ground-Mount 0 Level l❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desiredd,or as required by the Inspector of Wires.
Estimated Value of Electri /�����JjjjjV''yyyy'o/�j9c 77 (When required by municipal policy) •
Date Work to Start: ) '/ y I ctions to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: 55 A-1❑or C-1 0 LIC.No.:
Master/Systems Licensee: LIC.No.: _
Journeyman Licensee: T fitey Ti AS LIC.No.: 1e36ur
Security System Business requires'a aDivisi n of 0 pationalu Liicensure"SA"LW. S-LIC.No.:
Address: 3/ /� it y I7U/10 AO Qa2y
47j
Email: d r Telephone No.: i- 6751
I certify,under the pa nd files of perjury,that the inforur ,00 ton th/ p��aill is is true and complete.� / (�/
Licensee: � Print Name: 1� j(Key A f/77 Cell.No.: J vo77b' 6g
INSURANC RAGE:Unless waived by the owner,no permit or the performance of electrical work may issue unless the licensee
provides proof f 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. D/
CHECK ONE: INSURANCE® BOND 0 OTHER 0 Specify: I mede(44e_/f COr
OWNER'S INSURANCE W ER: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 0
Owner/Agent: Tel.No.:
Signature: Email.: E '•
.__
MAY 01 026
..I A
:UILDING .SPAR MENT
By: