HomeMy WebLinkAboutBLDE-26-836 1 Commonwealth of Massachusetts OfficialUse On j
Permit No.:��7,tp—'�j,ea
V - Department of Fire Services Occupancy and Fee Checked: ��-
i; BOARD OF FIRE PREVENTION REGULATIONS [Rev.vzoz3l
CI ='` APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
W T CO*o Town of: YARMOUTH Date: �.¢��
>i To the spector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
W \'�' Locgtioli(Street&Number):,3 J✓AGQ Ji L t,u E e,iccLE Unit No.:
Ovigr 4r Tenant: }Boss /1 i t.ce Email:
WI Owt r'9 Address: Phone No.:
Is dirt permit in conjunction with a building permit?(Check appropriate box)Yes® No❑Permit N
ce --1Vrplisolof Building: 7 .s i 1,74 N L. Utility Authorization No.: 7D/I/.R 24
nxistmg Service: /p o Amps/ya/Roo Volts Overhead r Underground❑ No.of Meters:
. New Service: .Zoo Amps /2o/,?}e Volts Overhead la Underground❑ No.of Meters: l
. Description of Proposed Electrical Installation: jviAe,/-,I2,YeiJ 4- A1.L ,uesJ ,Se vcCs
Completion of the following table may be waived by the Inspector of Wires.
No.of Acceptable Outlets: No.of Switches: f Generator KW Rating: Type:
No.Luminaires: 3 No.of Recessed Luminaires: r 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-Gmd.❑ 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 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy)
Date Work to Start: /92I Inspections to be requested in accordance with MEC Rule 10,and upon completion.
. FIRM NAME: -... 0 Brg1 J.dA4g Flita JLEtrR[c,dA) A-1❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee:— LIC.No.: ,�/,,9t6/
Security System Business requires a Division of Occupatipnal Licensure"S"LIC. S-LIC.No.:
Address: ,0. 4&' /a7L 5,/e,ereoozK Ma oz6L4
Email: eaia ac/Ro ./,=ZRT.t'cci @ 1/,1,1400. eo M Telephone No.: Of-1B'd-0 5-,3.
I certify,under t ains and pe allies of pettury,that the information on this application is true and complete.
Licensee: Print Name: ,y ey--.I.Co.,eu ig ti Cell.No.: .�6?-1d`D-d S 3/
INSURAN COV RAGE: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 orne to the permit issuing office.
CHECK ONE: INSURANCE BOND 0 OTHER❑ Specify:
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❑
Owner/Agent: Tel.No.:
Signature: Email.: