HomeMy WebLinkAboutBLDE-26-1496 Commonwealth of Massachusetts Official Use 0114 I,
i! 41 / Permit No.: � 76 i f
�1 Department of Fire Services Occupancy and Fee Checked:
4 BOARD OF FIRE PREVENTION REGULATIONS
' =1Rev. 1/2023
—`'' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.00
City or Town of: YARMOUTH_
• Date: /di3/�,G
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): r ,e f LAd.
Owner or Tenant: ('h 2/'y� v T M t I/L , Email:
�• Unit No.:
Owner's Address:
/
Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No 'Permit No.:
Purpose of Building: % gs Z Cfo 17�
UtilityAuthorization No.:
Existing Service: Jae, Amps MO/.25/6 Volts Overhead Underground❑ g El No. of Meters:
New Service:
Amps / Volts Overhead D Underground 0 No. of Meters:
Description of Proposed Electrical Installation: Reflare e7ecclr,E .(fit-cC
Ton (14regole ZajA
#Ue ) _are( p er f Qce FeD +a �4 C Su rte I w,� yw,Y
I e OA
Completion of the following table may be waived by the Inspector of Wires. AAI Ye (Wire t. .s arsut omi'Sad
•
No.of Receptable Outlets: No.of Switches: Generator KW Rating: T e:
No.Luminaires: No.of Recessed Luminaires: yP
KW Rating:
No.Appliances: KW: No. Water Heaters: KW: No.Transformers:tors: Wind 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-Grnd.0 Above-Grnd. ❑ Hot-Tub
0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System
No.Air Conditioners: El No.of Devices:
Total Tons: Telecom System❑ No.of Outlets: —
No.Energy Storage Systems: KWH Storage Rating: SecuritySystem stem y El 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
OTHER: ❑ Level 1 0 Level 2❑ Level 3 0 Rating:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electri al Work: t,SQ D • J
Date Work to Start: (When required by municipal policy)
�D /2/2 6 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: At Ck(.. J CA51.44
A-1 ❑or C-1 ❑LIC.No.:
Master/Systems Licensee:
LIC.No.:
Journeyman Licensee: km i`C lIG•2 I Ch5JJ2 1311 c2 3
'1 LIC.No.:
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 2,SS3 Ol/e*/ss el) /t7/A40Gh1 AM O Ztn,VJ
Email: Yy1. Cu36✓I eieC'�"(.C.4vt OOtI oak.. Telephone77y Z/Z-/$S-?
C CtJY`'L No.:
I certify,under the pains a ses of perjury,that the information on this application is true and complete.
Licensee: Print Name: IC�/ /I - 7 2
INSUR E /M t!ASC1y� Cell.No.: 7`/- 2/2- ��,j
ERAGE: 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 ame to the permit issuing office.
CHECK ONE: INSURANCE BOND❑ 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 0
Owner/Agent: Tel.No.:
Signature:
Email.: