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Home My WebLink AboutBLDE-21-006995 Commonwealth of Official Use Only E �, Massachusetts Permit No. BLDE-21-006995 i'� � 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:6/3/2021 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) 7 JONQUIL RD Owner or Tenant THE ALEXANDRA D DEMPSEY CHILDREN TR Telephone No. Owner's Address 100 PARK RD, KENSINGTON, CT 06037 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service 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 Initiatine Devices No.of Ranges No.of Air Cond. To No.of Alerting Devices 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 ❑ 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 Ballasts Data Wiring: Heaters Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 ❑ BOND ❑ 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 my 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 q,e_ W-7A qi Leaa ere . ,17 ,IL.,= ennatotuvsakk off///assachudefts - • Official Use Only Q �.�7 c'�S �[c7 n[� C 1� el' / �(.Japarfi.t T Jarvicrt Permit No. C� L+= Occupancy and Fee Checked .= BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR.PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),5 7ivilt 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMAT1019 Date: ZJ City or Town of: YARMOUTH To the Ins /". of Wir : By this application the undersigned gives notice of his or her intention to perfwm the electrical work described below. r a ,°cation(Street&Number) / ) �4� Li J L. y 1 r ner or Tenant , i •Z f'j t-7—0" 4-11 c Al Telephone No. i =; wner's Address this permit in conjunction with a building permit? Yes ❑ No A (Check Appropriate Bo=) urpose of Building Utility Authorization No. °Existing Service Amps / Volts Overhead❑- Uadgrd 0 No.of Meters S�m._ iNew Service Amps / , Volts Overhead❑ Undgrd❑ No.of Meters ,_ . ,' pumber of Feeders and Ampacity ,J/L: t�-r.ri Location and Nature of Proposed Electrical Work: -ram Completion of the follawirvable may be waived by the Inspector of Wires. No.of Recessed Luminaires 1Na of CerT.-Snsp.(Paddle)Fans No.of Total Transformers KVA _ No.of Luminaire Outlets !No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above r—i In- ❑ No.ot tmer s cy Lighting erred. m.nd. 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 ra Initiating Devices C No.of Ranges Total No.of Air Cored. Tons No.of Alerting Devices �. Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Munial No.of Dishwashers Space/Area Heating KW Local❑Conneection ❑ Other S No.of Dryers Heating Appliances r -Security Systems:* 1 No.of Watereaters KW No.of No.of No.of Devices or Equivalent Data Wiring: Signs Ballasts No.of Devices or Equivalent _ No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No of Devices or Equivalent ti OTHER: c Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lec . I WtsSO (When required by municipal policy.) e. Work to Start: Li / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE G : 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 e to the permit issuing office. CHECK ONE: INSURANCE SI BOND 0 OTHER ❑ (Specify: e'Cf"j I f)..c'�Cc. / , • I certify, under the pains and penalties of perjury,that the informatio on this application is true and complete. FIRM NA 1 LIC.NO.: Licensee: ` '"'' i -cJ�;bci j<f' Signature at, it. s LIC.NO ('' "' k (If applicable,en "ez "in thel' a num Tel Bus.Tel.No.: Address: < L` nt - 0-2_cy� Alt Tel.No.: j "Per M.G.L.c. 147,s.57-61,security ork requires Departme of Public Safety"S"License: Lic.No. — 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 0 owner's agent. Owner/Agent Signature Telephone No. r PERMIT FEE: $ } _ .