HomeMy WebLinkAboutBLDE-26-1308 application Commonwealth of Massachusetts Official Use Only
tr � � Department of Fire Services Permit No.: �
Occupancy and Fee Checked:
Lif
-_11_ 4 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
`'' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performer in accordance with the Massachusetts Electrical Code(MEC), 527 C R 12.00
City or Town of: YARMOUTH_ � d 27 Zd
• Date:
To the Inspector of Wires:Hy this application,the undersi ned gives notices of his or her intention to perform the electr cal wo described below.
Location(Street&Number): W 13 F i op
c
Owner or Tenant: NW_4- Q j* 1 Dog54r' • I Unit No.:46 C 13
Owner's Address: S' , C C.�.?�L,�vr'�
hone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes Iiii4o❑Permit No.:
Purpose of Building: Cori D 0
Utility Authorization No.:
Existing Service: /00 Amps 1 i° /2Za Volts Overhead
� UndergroundEr-- No. of Meters: l
New Service:
Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Installation: w4�'t"( C' 6 /vim/ 12-00/hS Tor Qkostw i--;
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable Outlets: I p No.of Switches: g Generator KW Rating: T e:
� Z
No.Luminaires: 6 No.of Recessed Luminaires: yP
No. Wind Generators: Wind KW Rating:
No.Appliances: KW: No. Water Heaters: KW: No.Transformers:
Space HeatingTotal KVA:
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.❑ Above-Grnd. ❑ Hot-Tub❑ No.of Self-Contained Detection/Alerting D:eviq is No.Oil Burners: No.Gas Burners: Video Systemev ; o 2
No.Air Conditioners: Total Tons: y ❑ No.of Out cats. ___ _.
Telecom System 0 No.of Outlts: !
No.Energy Storage Systems: KWH Storage Rating: i
g Security System ❑ No,of Devices� aur, 2 7 2026
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply E ui merit: ;
No.of Modules: Roof-Mount 0 Ground-MountPP e q p I
OTHER: 0 Level 1 0 Level 2❑ Level 3 0 Rai C
By
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Elec ical ork: Li-OW (Whenrequired by municipal policy)
•
Date Work to Start: Z$ Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: OE tJ Q CITAIO agi
A-1 0 or C-1 0 LIC.No.: F 3 ,Z„7(
Master/Systems Licensee:
LIC. No.:
Journeyman Licensee:
LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: )`F mpiHnoteb,r ? �?r (,it. tycii I
Email: 0 t'►t C(($J9 e }4. G/t^ L�� 7711`t`
Telephone No.: (67) 97.2 UO 07
I certift,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: /6/I01 Ct t' D Print Name: '/L-�/v1,,, ) (-j /,/} /
Cell.No.: 6i`7 S72 vYo?
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"comp d operation"coverage or its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of sa a to the permit issuing office.
CHECK ONE: INSURANCE BOND IDOTHER❑ Specify: 5ik . id-P-I i
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.: