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Home My WebLink AboutE-18-5626 aLq Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-18-005626 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:4/9/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 6 ELIZABETH LN Owner or Tenant KERMENSKI RICHARD F Telephone No. Owner's Address KERMENSKI ANN B,6 ELIZABETH LN,WEST YARMOUTH,MA 02673 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: New kitchen 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 KVA No.of Luminaires Swimming Pool Above 0 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 Number Tons KW No.of Self-Contained Totals: Detection/Alertine 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 OTIIER: Attach additional detail idesred 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: Richard F Kermenski Licensee: Richard F Kermenski Signature LIC.NO.: 19807 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:6 ELIZABETH LN,W YARMOUTH MA 026733441 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: $75.00 eve., yea bg , P4\50-c__ Vit/iege V y _ l.gmmonru<at*Ja of mast4,tsa(f5 -�n7al TJ6e Only/ / cc77 ��'77 Permit No. Gf€ 'SW74- • ' lie af:crl+nect ei..*iry services • -Jac" ' VEOccupaney and FeeChecked---�C"•ZSC BOARD OF FIRE PRENTION REGULATIONS Rev. 1/07] ' 0 blank) APPLICATION 'FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be pe formed in accordance with the Massachoseas Elton-lad Cot C),5' CMP.12.00 (PLEASEPRINT lNINK OR TYPE ALL LVFORM4T707t9 Date: cp // City or Town of: YARMOUTH To the I ectof of Wires: • By this application the lmdejsigned gives notice of his or her intention to perform the electrical work described below. • . Location(Street&Number) C Ell/ Z A/3 krui L A-w ra. Owner orTenant g (Cairl-t,p Ken."Art"I.S e I Telephone N . -77 �y..5^s Owner's Address re Is this permit in conjunctionpwith a buMd'ing permit? Yes Ho ❑ (Check Appropriate Eat) Purpose of Baf[d'mg 1� R5,b eA/r11� L I Utility Au�Orizatioa N0. 1 ci r---^- I Eustiag Service_ Amps / Volts Overhead Q Und,rd❑' No.of Meters �_ 1 i_ New Service _- Amps / Volt Overhead Und d o ❑ ❑ No.of Meters c" d I Number of Few rs and 4mgadty • L rT ljj O t ,l Location Wort'Nature of Proposed Electrical Wor Alv k7 l -c 4F /12 v dI _ _ W Completion afthefa7lmvm_table may be waived .. . by the IrsDecfar arae. l� s No.of Recessed LamizaL a No of Celt-S INo.ofTotal csp.(Paddle)Pans Transformxs „`-- No.of Lamin2ire Outlet No.of Hot Tubs 'Generators ICVA ' No.ofLum 9 +e SwimmiagPool Above In- µ�1v`1u of �.mergeucylagnnng - orad. 0 d- 0 IB tterytaits No.of Receptacle Outlet . No.of Oil Barnes 'FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No,of Detection and ' L ins - _ Iaftiatine ces DeeiNo.of ges Na.of Air Cond. Total No of Alerting Devices L No.of Waste Disposers Heatenmp I Number I'Tons IKW No.of Self-Contained - Totals: Detection/4lertine Devices No.of Dishwashers Space-Arta Heating KW' t Municipal No.of Dryers Heating Local❑Connection 0 &l? Iran KW Security Systems:, _ ti No.of Water Appliances No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring Sins Ballasts No.of Devices or Equivalent °' No.$ydromasszge Bathtubs Telxommaaicatioas Wiring: No.of Motors Total HP Na of Devices or % OTSER Equivalent Attach additional detail rderired or as required by the Inspector of Frau. f`i Estimated Value of le cal Wo rk (When required by municipal policy.) Work to Start Yj&i / Inspections to be requested - `"\ INSURANCE COVERAGE: Unless waived by the owner,no ermit for the pc:forrmaace of electrical work,and upon lyi� V the licensee provides proof of liability coverage issue unless "r tmdets geed certifies that such coverage ism force,and has exhibited proof f same to permit issuing office. Thevalent iCHECK ONE: NSURANCE 0 BOND 0 OTHER 0 (Specify;) I certify, wider th atns rend peneltes ofpedu y,that the information on this t. PERM NAME: t f appkca>ron is true and complete. r R /� ( { /tb k<CA,yyt'alyS.ri LIG NO: l O Q License= (If applicable,enter" S'rgnatm e �� Q 4.1.144; LIG NO.: I ezerrrpr"in the License number fine) `�"'� Address Das.TeL No��— J `Per M.G.L. c 147,s.57-61,securitywork requiresAlt Tel.No.: �— OWNER'S INSU CE W Departnent of Public Safety"S"License: Lie.No. �" ,7c ro by]IN AVER I em aware that the Licensee does nor have the liability' coverage n—OX fly guired my 'pante be ow,I hereby ve this requirement. I am the(check one) owner 0 owner's a eat. t Owers/Agen . / I Signature K (.,.t An Telephone No. 57/144. Is- PERMIT FEE: $