HomeMy WebLinkAboutBLDE-26-1488 RECEIVED ;
Commonwealth of Massachusetts Official Use illy
OCT
�' = l Department ofFire Services Permit No.:
Occupancy and Fee Checked:
BUILDING t =I1— �; OARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
----__ _By ."' APPLICATION FOR PERMIT TO PERFORM ELECTRICA WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC), 527 CMR 12.0 City or Town of: YARMOUTH_ a �?�
Date: �-
To the Inspector of Wires:By this application,the un�rsigned gig no ices of his or her intention to perform the electrical work described below.
Location(Street&Number): /71 i
Owner or Tenant: YJa Unit No.:
nu7-14 ,c9k-/, t`i ci/1/4(Email: /)//t1c /ce- Af z/Z---- ZKoee 41I,(-"'"
Owner's Address: it;cNAi 01- P-!'1o�r/1
/� ('-' Phone No,: 77V-4g-- at Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑Permit No.:
Purpose of Building: rti1 /jp 1 Utility Authorization N .:
Existing Service: a X Amps d ar / y�Yc>Volts Overhead Underground[� I
New Service: � g No. of Meters: /
�} Amps / Volts Overhead❑ Underground❑ No. of Meters:
Description of Proposed Electrical Installation: 6,//Q� e /Q
/Jl4/et6'v//d.\/ / )6—dE A
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: yp
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-Grnd.❑ Above-Grnd. 0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System
No.Air Conditioners: Total Tons: — � No.of Devices:
Telecom System❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: SecuritySystem
Solar PV KW DC Rating: Solar PV KW AC Rating: y No.of Devices:
No.of Modules: Roof-Mount 0 Ground-MountNo.of Electric Vehicle Supply Equipment:
0 Level 1 0 Level 2 0 Level 3 0 Rating:
OTHER:
Attach additional detail if desired, oras�required by the Inspector of Wires.
Estimated Value of Electrical Work: V a(�,�t -&
(When required by municipal policy)
Date Work to Start: /t) ?- a6 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: ..r'sc 4t ML� L/jZ Ts?/G 1/4 I A-1 ❑or C-1 ❑LIC.No.: /. ///- 3
Master/Systems Licensee: LIC. No.:
Journeyman Licensee: '' Lfk,/lp e LIC.No.: /1//I-- v
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 9 t yeb/` l A/Z:- cnc: N- yi,440,t 1-1- "if t� �r�/`L
Email: " " !�C r=eiti24 e/coC(le/� cJ GMAt i . GD� . Telephone No.:, 77 - C 7q
I certify,under ie pains a penalties of perjury,that the information on this application is true and complete.
• Licensee: - Print Name: ` -� /� 77cf 79 1
---k� � l� Cell.No.:
INSUR E COVERAGE' n ess 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 its substantial equivalent.The undersigned certifies that such coverage
is in force and has exhibited proof of same to the permit issuing of e.
CHECK ONE: INSURANCE El BOND 0 OTHER Specify: S'TtL f I /At ,t4,tc'4_—
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.:
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