HomeMy WebLinkAboutBLDE-26-777- Commonwealth of Massachusetts Official Usscg4.7
me-=` Permit No.:�'L/o` / /
_,W1 Department of Fire Services Occupancy and Fcc Checked:
_.1 , BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/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: YARM OUTH Date:,5—/y-,366
To the Inspector of Wires:By this application,the un igned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): [PO v/LI /'lfi St Unit No.: /
Owner or Tenant: � Email:
Owner's Address: K o�ber1ii9 Crrkic� Phone .: 6/2 c rGV 34 s0
Is this permit in conjun"'on with}building permit?(Check appropriate box)Yes❑ No IP-Permit No.:
Purpose of Building: I i5!dC!4Ce' Utility Authorization No.:
Existing Service: i Amps/t 7 4(n Volts Overhead a ynderground❑ No.of Meters: 7
New Service: 610 Ampyr O Volts Overhead Underground❑ No.of Meters: /
Description of Proposed Electrical Installation:
•
RFrE-IVE
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type: tiS •
2 I . 7
No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: TotalKVA: o n,u 6 gRTMEFs
Space Heating KW: Heating Equipment KW: No:Motors: Total HP: Total KW: By _
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices:
Swimming Pool:In-Grad.❑ Above-Gmd.❑ 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: RECEIVED
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: MAY
No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 El Level 2 0 Level 3 0 Rating: j
OTHER: Ifo ESL i�
BUILDING DEPARTMENT
�11 j ny.
Attach additional detail if desired,or as require�/by the Inspecto ojWires. �'1 /� `
Estimated Value of El trice ork: O��/T(/ /2"/ [/m 5F (When required by municipal policy) •
Date Work to Start• inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: (1I ii4ivr / 2/ ( y A-1❑or C-I ID LIC.No.:
Master/Systems Licensee: / LIC.No.: al&T7UV
Journeyman Licensee: j„2<pziDV • LIC.No.:
Security System Business requires a Division
Soff Oen a'ono)Licensure"S"LIC. SS-LIC.No.:
Address: o / /" /� J/(/ tdoe& g p/ d C/ f �/
Email: I . Telephone No.: C j)g
I certify,u der the pairs d pena ties of perjury,that the information on this application is true and complete.
Licensee: 1/lfjih fi/9 ' Print Name: Cell.No.:, �72
INSURAN E COVERAGE:Ut 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 of sdme to the permit issuing office.
CHECK ONE: INSURANCE CO BOND 0 OTHER❑ Specify: 41l i�y
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the 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.:
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