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Home My WebLink AboutBLDE-21-002857 '. /�k. Official Use Only or , Commonwealth of fil l Massachusetts Permit No. BLDE-21-002857 ``3$ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07] 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:11/18/2020 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 26 DEVEAU LN Owner or Tenant Pauline Judge Telephone No. Owner's Address 26 DEVEAU LN,YARMOUTH PORT, MA 02675 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 ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Rewiring. 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 ❑ 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Signs 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 if desired,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 ofperjury,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: $75.00 2 .tJ62-/' kL - r C mp:ow/ea ir,of Massachusetts Official Use Only 7 �, _ Permit No. BOARD OF REGULATIONS Occupancy.and Fee Checked FIRE PREVENTION v. I/07J (leave blank) APPLICATION FOR=PERMIT TO PERFORM ELECTRICAL WORK All wort to be performed in accordance with the Massachusetts Electrical Code(ME 527 12.00 (PLEASE PRINT'1NINK OR TYPE ALL INFORMATION) Date: 1l ` Z.S.) City or Town.of: YA. t OUTH To the fncpe r of By this application the-undersigned gives notice oher intention to perform the electrical work described below. . Location(Street&Number) 2, ( , fDA 6,A (I Owner or Tenant /i al-( lk (— \ T i PG-'1,5 Telephone No. Owner's Address Is this permit in conjunction ' a building permit? Yes No Purpose of Building , UM L-- 0 (Check Appropriate Box) 1 Utility Authorization No. Existing Service Amps I Volts Overhead Q Undgrd 0 No.of Meters New Service Amps I Volts Overhead❑ Undgrd Number of Feeders and Ampacity No.of Meters Location and Nature of Pro_posed Electrical Work: f C-V- VC/CV(r' (`4 f'LZ n �1 Completion of the follawurg amble may be waived bb'the Inspector of Wires. Na.r of Recessed Luminaires IND.ofCeiL-Susp.(Paddle)Fans No.of Total TransNo.of I.ataittacire Outlets Generators owners KVA.No.of Hot Tubs Gener KVA • No.of Luminaires Sig Pool Abod-ve ❑ In- i}vo.of E:mergeacy Laghtmg wind_ ❑ Bat#erp IInits No.of Receptacle Outlets No.of Oil Burners . ALAR V S_IN*.of Zones No.of Switches No.of Gas Burners 'No.of Detection and Initiating No.of RInitiating Devices anges jNo.of Air Cond. Total -No.of Alerting erting Devices No_of Waste Disposers !Heat Pump 1 Number 1 Tons I KW No.of Self-Contained Totals.r 'Detection/Alertiaz Devices No.of Dishwashers -SpacefArea Heating KW Local❑Municipal C..) Cnanection ❑ Other No.of Dryers Beating Appliances KW Security y x J No.of Water , No.of Na No.of D or Equivalent ias Ballasts Data Wiring; Heaters S No.Hydromassa a BathtubsNa of Devices or Equivalent I,, g No.of Motors Total HP Telecommunications Wiring V OTHER: No.of Devices or Egniva1ent Estimated Value of Et cal Wor 611) Attach additional detail tf desired or as required by the Inspector of Wires. �' Work to Start (When required by municipal policy.) to Start C 'ons to be requested in accordance with MEC Rule 10,and upon completion. 0"- GE: Unless waived by the owner,no permit for the perfonnance of electrical work may issue unless the licensee provides proof of liability insurance including"completed ca mp operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the CHECK ONE: INSURANCE BON} ❑ O P �t issuipg office. 3 > I certify, under the pains and penalties o ❑f rS fY �� ire m i " `/��v / �, FIRM NAM of that the information this app rrrK u true and complete. S Licensee: �t S LIC.NO.: �faPPlicabl Wit•.in t license Swat LIC.NO.� Address: 0Y 24r�► �) I A. d 3? Bus.Tel.No.: j *Per M.G.L.a. 147,s.57-61,security work requires Department of Public Saf Alt TeI.No.: OWNER'S INSURANCE WAIVER: I �},"�"License: Lie.Na. am aware that the Licensee does not have the liabili required by law. By my signature below,I herebyty insurance coverage n�orczlally 7 Owner/Agent waive this requirement I am the(check one Elowner ❑owner's eat Signature Telephone No. PERMIT FEE: S