HomeMy WebLinkAboutBLDE-26-791 Commonwealth ofMassachusetts Dff, a us
**_ � Permit No.:
milt Department of Fire Services and Fee Checked:
�� BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occupancya]
=_ APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 CMR 12.00
City or Town of: YARMOUTH Date: 373/2,020
To the Inspector of Wires:By this application,the undersigned vees n ti es of his or her intention to perform the electrical work de cribed below.
Location(Street&Number): G. Unit No.:
Owner or Tenant: by//eLre 7Pfh{i._/ Email: p...CO K ri 4r Le.; i` . C.117W1
Owner's Address: Phone No.: 9 Z •
Is this permit in conjunction with a building permit?p (Check appropriate box)Yes El No[ ermit No.:
Purpose of Building: ed�/f€✓/C,7Q,,` Utility Authorization No.:
Existing Service: Amps / Volts Overhead 0 Underground 0 No. of Meters:
New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters:
Description of Proposed Electrical Installation: Rifyp eac,-rl t u-gc2y CP,viol /430,e4,-
poJc5 -fa pre9are foV' c€,ktri1 o' er- -1-k,2 cpa/gicS.
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 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 0 Ground-Mount 0 I Level 1 ❑ Level 2 0 Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or s required by the Inspector of Wires.
Estimated Value of Electrical Work: /5-OD (When required by municipal policy)
Date Work to Start: 4/0/Z{p Inspections to be requested in accordance with MEC Rule 10,an upon completion.
FIRM NAME: Da.nri etp4Ji€Se A-1 0 or C-1 IC.No.: ,aV tS,5,$t,
Master/Systems Licensee: fa:10025//1/49 LIC.No.:
Journeyman Licensee: 509(/4/E" LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: fq
Address: /7 SSt lz... :n .Sf , 6!'lmil cola_a2(2 . 1C4 11-10/P26 q
Email: Dal)h O e ecirrI j 1(4
— l4 -6e)44 TelephoneNo.: C 2, U'O(z.l)
I certify,under tTie pains and enalties of per'ury,that the information on this a lication is true and complete.
License • rint Name: ay/0 rips 'Z Fell.No.: Lfg 2s-a 1/
IN ANCE COV E: ess waived by the owner,no permit for the_rformance of electrical work may issue unless the licensee
provides proof of li ility inclu • g"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage ��
is in force and has exhibited of of s o the permit issuing office. /,,G �n / ,`„ ��� l/,c�/ .5
CHECK ONE: INSURANCE ND 0 OTHER 0 Specify: (/� �•tG-'�
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❑ Owner's agent 0
Owner/Agent: Tel.No.:
Signature: Email.:
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