HomeMy WebLinkAboutBLDE-26-1477 application Commonwealth of Massachusetts Ogle seOe 77
Permit No.: Y...‘..
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I.a9lIl!— Department of Fire Services Occupancy and Fee Checked:
-._'l= •: BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/2023] -
•" •-N APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5;7 C 12 00
City or Town of: YARMOUTH_ Date: /d eo '242
To the Inspector of Wires:By this a,Qplicalionthe yargned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number):m r//y /�l 60/� Unit No.: 7/V
/
Owner or Tenant: T 4 4. t2U,i).LE-J?1"/CZ Email:
Owner's Address: Phone No.:Is this permit in conjunction with a building permit?(Check appropriate box)Yes r6 No ElPermit N_ J7 C eh,-7 I
Purpose of Building: 1-7. 01fC61710J*L. Utility Authorization No.:
Existing Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
' New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters:
Description of Proposed Electrical Instal p►�tion: 1;:k° LJ nre.t=A- ?s1E L-- 7E I t r ,
2�3 P 1= Kj c.IJ 5
Completion of the following table may be waived by the Inspector of Wires. OCT n% 2(26
No.of Acceptable 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 0 No.of Devices:
Swimming Pool:In-Grad.❑ Above-Gmd.0 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❑ 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❑ Ground-Mount❑ Level I❑ Level 2❑ Level 3 0 Rating:
OTHER:
Attach additional detail if desired,or as req fired by the Inspector of Wires.
Estimated Value of Electrical W°fk: .. Da) (When required by municipal policy)
/O Date Work to Start: ,0 "f p Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: A-I 0 or C-I❑LIC.No.:
Master/Systems Licensee: LIC.No.:
Journeyman Licensee: ,sf littiP leo r jt( LIC.No.:L=2. 7 te r}
Security System Business r tyres a Division of Occupational Licensure"S"LIC. . Q S-LIC.No.:
Address: )�, ,7(. .=tJ c%5 t-7 I"I C)-®7,q,P
Email: 9—d 9 Jf• �L i ei� C -MML- Na'fte��l,e�phoneNo.:V6-P6 0co77�
I certi,un th41;ns a penalties//yf perjury,that the information on this a lication is true and complete.
Licensee: / ! Print Name: hL )f,y / I.aI Cell.Nod fti(�
INSURAN E 0 'RAGE:Unless awed by the owner,no permit f r 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 a to the permit issuing office. C I r
CHECK ONE: INSURANCE BOND 0 OTHER ElSpecify. G L t L`'j-"j J L= /
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the liability insurance cove a 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.: