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HomeMy WebLinkAboutBLDE-26-874 RECEIVED ! SUN 1 02026 ' ov ItYV(o Commonwealth of Massachusetts Official use o BUtt. TMENT Permit No.: 0-2.z',—u 7 - Department of Fire Services Occupancy and Fee Checked: 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(MECf)�527 CMII IA0 City or Town of: YARMOUTH Date: Yd lC .pLV/ To the Inspector of Wires:By thi app`igation c undersigned given nQliccs of his or her intention to perform the electrical work described below. Location(Street Number e' 1I_1� Y�0. � {11��1 rat No.: I� Owner or Tenant: LC�e 2 -vegan Email:�Z� SSrlc3 a�01 mot Owner's Address: 4,3DS rt ,` hone No.-'TIL- ,to�D-OQQ�� Is this permit in conju Lion wi buildin permtt7(Check ropriate box)Yes No 0 Permit No.:ZIctr-2 �.-3 Purpose of Building f\L- tri, epe\e Utility Authorization No.: Existing Service: Amps / Volts Overhead❑ Underground 0 No.of Meters: New Service: Amps / Volts Overhead 0 Underground 0 No.of Meters: Description of Proposed Electrical Installation: \ 'vtc , 7)ocy( -43 ©uije-J s. 5 h.,t. '"Y f It f3 h ck^4 V' sac-.fib to( 13 v R _- S.e"`xr1_ Completion of the follow* 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-Grad.❑ Above-Grnd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gm Burners: Video System ❑ No.of Devices: No.Air Conditioners: Total Tons: Telecom System❑ 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 Level I❑ Level 2❑ Level 3 0 Rating: OTHER: Attach additional debit if desired,or as r uir b the Inspector of Wires. Estimated Value of Electrical Work:� by • cI) (When required by municipal policy) • Date Work to Start: Ins ections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: A-I❑or C-1❑LIC.No.: Master/Systems Licensee: LIC.No.. Journeyman Licensee: LIC.No.: Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: Address: Email: Telephone No.: I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: Print Name: Cell.No.: 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 such coverage is in force and has exhibited proof of same to tile permit issuing office. CHECK ONE: INSURANCE 0 BOND❑ OTHER❑ Specify: OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurancesoverage normally B I1 required by law., signature below eby waive this requirement.I am the:(Check one)Owner I o nerr''s agent❑ Owner/Agent` " 1 N C h e\V___ � 5 .-s-N Tel.No.n,L --fa(p R-. C)d"l'}. Signature: , ` SZCN Email.:C-6-..skIrynP.s0n4:7,ail a chA1-a ,