HomeMy WebLinkAboutBLDE-26-1117 RECEIVED
1U '126 Commonwealth of: Massachusetts C.7. Use �ly("7
Permit No.: L
j Department of Fire Services Occupancy and Fee Checked:
BUILoi ' i -? BOARD^ OF FIRE PREVENTION REGULATIONS [Rev.l/2023]
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APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfor�,ed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
City or Town of: 5 ert-t ou+4 Date: 07—/5--
To the Inspector of Wires:By this application,the undersigned gives noticesnotices of his orh r intention t9w r orm the electrical work described below.
Location(Street&Number): 'J Ctr-oWefJ leoc_o{ 'Dtri'l INN S7'14N,a,J
Owner or Tenant:McPhee/9s3`.- ' 44.-Afa.<alai"Aer VEmail:SK420*.oeLQe4ssoe-4;::e,rine.C-.m,
Owner'sAddress:(3cP3 Rorr{e/34E- r.5is,Avel 2 a644/ Phone No.:-6-4'-38.r 39054
Is this permit in conjunction with a builds permit?(Check appropriate box)Yes rir No 0 Permit No.:
Purpose of Building: Rest'otehff¢I 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: Le Vat .SQ 4 eu-cQ
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® No.of Devices: '
Swimming Pool:In-Grnd.0 Above-Gmd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: 7
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® 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 0 Level 2❑ Level 3❑ Rating:
OTHER: FfoosR .Ssi/ISLr3-(2);/Het-f lots 14e,"..,cS--{-Zi-e(A)
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: 7•rd �°1 (When required by municipal policy)
Date Work to Start:OR-0/-0-6 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: Seaside Alarms,Inc. A-I 0 or C-I®LIC.No.:4177
Master/Systems Licensee:Robert K.Boucher LIC.No.: 1317-C
Journeyman Licensee: LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: SS-003436
Address: 1265 Route 28 South Yarmouth,MA 02664
Email: dazalseasidealarms.com Telephone No.: 508-394-0599
1 certify,un t e pains nd allies perjury,that the information on this application is true and complete.
Licensee: ✓ rint Name: Robert K.Boucher Cell.No.: 508-364-1694
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 the permit issuing office.
CHECK ONE: INSURANCE❑x BOND 0 OTHER 0 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 0 Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.: