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Home My WebLink AboutE-19-1364 • 0 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-001364 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.l/07) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:9/5/2018 City or Town of: YARMOUTH To the Inspector of Wirer By this application the undersigned gives nonce of his or her intention to pertorm the electrical work described below. Location(Street&Number) 108 STARBUCK LN Owner or Tenant GOLLIFF FRANCIS R Telephone No. Owner's Address GOLLIFF NANCY JANE, 108 STARBUCK LN,YARMOUTH PORT,MA 02675-2418 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install generator. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 22 No.of Luminaires Swimming PoolAbove ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump l Number Tons KW No.of Self-Contained Totals: r Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail fdesired.or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance 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 0 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application Is true and complete. FIRM NAME: HENRY LARKOWSKI Licensee: Henry Larkowski _ Signature LIC.NO.: 26990 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:91 HOKUM ROCK RD,PO BOX 267,DENNIS MA 026380267 Alt.Tel.No.: 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK _ All work to be performed in accordance with the Massachusetts Electrical Code,(NEC),527 CMR 12.00 4". , of r4"*g, g4—t3lpgTI�} lcmteEEb1.�1/ E D TOWN OF YARMOUTH By CKa��Z Fee: $ SEP 05 2018 �✓„J PERMIT NO. BUILDING DEPARTMENT By: (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: To the Inspector of Wires:By this application the undersigned gives notice of his or her intention to perform the electrical work described below. .0g S7 Pala' Location (Street&Number) �/� Owner or Tenant A ' . L . Telephontf`"lee P I. Owner's Address w✓ t_ Is this permit in conjunctio •th a building permit? 0 Yes;ZNo (Check Appropriate Box) Purpose of BuildinginD�(•� Utility Authorization No. Existing Service.( Amps /2 f) /7POVolts Overhead Undgrd 0 No.of Meters 1 New Service Amps I Volts Overhead Undgrd 0 No. of Meters Number of Feeders and Ampacity lir / Location Nature of Proposed electrical Work: A! rCif 72 /R' f rrt x ll Yr - 40laYaie— if 6 if'lc api-Als- sal rr,-f Co Anion the allowin. table ma be waived. then sector. Whet o.o Total No.of Recessed Fixtures No.of Ceil.-Susg.(Paddle)Fans Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA Above ,.-.1In- No.of Emergency Lighting No.of lighting Fixtures Swimming Pool grnd. grnd. ❑ Battery Units 'No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.ofInitiating tand Initiaatinngg DDeevices Ttal No.of Ranges No. of Air Cond. Tons No.of Alerting Devices Heat Pump I Number Tons KW No. of Self-Contained No.of Waste Disposers Totals: `— DetectiordAlertin" Devices Municipal 'n Other No.of Dishwashers Space/Area Heating KW Local 0 Connection No.of Dryers Heating Appliances KW 'Sec No.of yDevice: �Y g No. Devices or Equipvalent No. of Water No.of No.of Data Wiring: Heaters . KW Sins Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications conorEgui Wiring: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE Unless waived by the owner,no permit for the performance of electrical work may be issued unless the licensee provides proof of liability insurance including"completed operation"coverage w 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 A BOND 0 OTHER (Specify:) SC=( ( l6:11A c-i- gig rj (• p oon Date) Estimated Value ec Work: v. �� (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify,under th ai s and penalties of perjury,that the info -j•. this application is true and complete. FIRM NA :: a _ Q LIC.NO. Licensee: a_ jiT� /i 1� rif Signa. . :�j4$ flc LIC.NO.J b l D (If applica3'e, `ere .t"in the license ober ) Bus.Tel.No.: -413 Address' UP (} .tl& ? •- S/It� Q ��p 3P Alt.Tel. No.: err (DST`( OWNER'S INS CE WAI I a ware that the Licensee does no have the liability insurance coverage normally required by raw.By my signature below,I hereby waive this requirement.I am the(check one)owner 0 owner's agent.0 Owner/Agent 50 j