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Home My WebLink AboutBLDE-21-006051 Commonwealth of'4\ Official Use Only 0feh:141 Massachusetts Permit No. BLDE-21-006051 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:4/21/2021 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) 45 SALT MARSH LN Owner or Tenant Susan Kinnear Telephone No. Owner's Address 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: Replace meter main Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 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 Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number . Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Space/Area HeatingKW Local ❑ Municipal 0 Other: No.of Dishwashers P Connection HeatingAppliances No.of Dryers PP 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 Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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 ❑ (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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 Commonwealth o/Massachusetts • Official Use Only `�!__/ Service-5 Permit No. - - t�S i _= ep al re S � Occupancy and Fee Checked --..,., ,-_ BOARD OF ARE PREVENTION REGULATIONS I 'ev. I/07] eave Blank APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To By this application the undersigned giv4554L.y tice of his or her inten-on to perfoethe�ctrical o k described below. Location (Street&Number) — �5 • Owner or TenantYl.5J /Ai r�� Owner's Address J Telephone No. „ism /�j6G Sl W, Is this permit in conjunction with a building permit? Yes ❑ Na X (Check Appropriate Boz) Purpose of Building � Utility Authorization No. Existing Service>�_`( ''A ps /2O/ g4 f Its Overh . 1 ead� Undgrd ❑ No.of Meters New Service eed)(J()Amps /24 j/ _71 olts Overhea Undgrd ❑ No,of Meters �_ Number of F ers and Ampacity `? ,-j `e 'C Location and Nature of Proposed Electrical Work: 7 Aic c J 7 t,�r Alit L5 � (J'/t k �Z n� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cal.-S (Paddle)Fans No.of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimmia Pool Above In- No,oI l!,mergency Lighting g mad. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges Initiating Devices No. of Air Cond. TO • Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons H KW No,of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Lora!❑ Muaicipal V No.of Dryers C0� 0II � rY Heating Appliances �, Security Systems:*' No.of ater No.o No.of Devices or E trivalent J Heaters o.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: . OTHER: No.of Devices or E uivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o ectri I Work;i.2.2022.t._-:=-_ (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. r- INSURANCE C VE GE: Unless waived by the owner,no permit for the performance of electrical work mayissue 1_1 the licensee provides proof of liability insurance including unless undersigned certifies that such coverage is in force,and has Lexhibit d proof of same to the permit issuingcoverage or its substantial office., CHECK The CHECK ONE: INSURANCE BOND I certify, under the pains an penalties o 0 OTHER ❑ (Specify: ��1--r 6 S fp 1 ry,that the information n this kfifTc n'uVtrue afte tAp /�Z' FIRM NAM : LIC.NO. 11 Licensee: E" _—_ (If applicable.e te"exempt"in the license number line.) C./Sigma �L? � - LIC.NO.: Address Bus.Tel.No.: .l "Per M.G.L. c. 147,s.57-61,security work requires D �PublicAlt Safety"S"License: Lic.No.- OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normal ly required by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner o Owner/Agent ❑owner's a ent Signature I Telephone No. PERMIT FEE: $