HomeMy WebLinkAboutBLDE-26-1476 Commonwealth of Massachusetts Official
_ Permit No.: (-!J.,-l`I-76,
'I „tin s Department of Fire Services Occupancy and Fee Checked:
e`ely BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023] -
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•—N' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 CM 12.00
City or Town of: YARMOUTH Date: /° s pi,
To the Inspector of Wires:By this applieati the undersigned gives notices of his or her intention to perform the electrical w rk de ibed below.
Location(Street&Number): 0 r L 7-)1,(f¢1 S Unit No.:
Owner or Tenant: /i R(-,T1-g- P_UVJL Email:
r` Owner's Address: Phone No.:
Is this permit in conjuncti with a bu ding permit?(Check appropriate box)Ye.1X No❑Permit Not l 1f'_Zp-3 4 0
M Purpose of Building: i p p1 /?-j r)ON Utility Authorization No.:
'''J Existing Service: Amps / Volts Overhead❑ Underground 0 No.of Meters:
New Service: Amps_/ Volts Overhead ElUnderground❑ No.of Meters:
��) Description of Proposed Electrical Installation: /1-1o1✓�5 A)tEv.5 P-141 lUSt r4 SAra ,�1� r=�
uv •
f 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: 2026
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: L [U
4 Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
r
-�I No.Heat Pumps: Total KW: Total Tons: Fire Alarm System CI No.of Devices:
Swimming Pool:In-Gmd.❑ Above-Gmd.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System El 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❑ Level I❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work-d -}- /2C�C' (When required by municipal policy)
Date Work to Start: JtS/ (y/�3 4_ Inpections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: I A-1❑or C-1❑LIC.No.:
Master/Systems Licensee: LIC.No.:Journeyman Licensee: )J J 5 �.<OJ f LIC.No.: E 2,/�lQ
9
Security ,System Business
Buusiness requires a Division
�orf OccupationalccZ Licensure"S"LIC. S-LIC.No.:
Address: / OY 2 / wCNg(1_S I Pr- C)7 c�cr
Email: .0 -( J 99 i p 4 M t,t 6, Telephone No.: 521,r,,(a 77 44
I certify,and t e ins and penalties of perjury,that the information on this application is true and complete
Licensee:ik y • ,C Print Name: = yry 444:ndf c�K.i Cell.No.: t,)-)1'l
INSURANCE CO E•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[ BOND❑ OTHER❑ Specify-S-C 1.C;"C-1-}1,(L,- .3/ ''''eOWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance co erage 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.: