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Home My WebLink AboutBLDE-23-002452 Commonwealth of Official Use Only ORANI Massachusetts Permit No. BLDE-23-002452 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:11/3/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned yes notice of his or her intention to perform t e al work described below. Location(Street&Number) ELVILLE RD UNIJ. 1 Owner or Tenant JAMES ATON Telephone No. Owner's Address 50 MELVILLE RD, SOUTH YARMOUTH, MA 02664 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: Wiring for addition on rear. 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. Ton l No.of Alerting Devices 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 Ballasts Data Wiring: Heaters Signs 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 my signature below,I hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 it 1-47,7) 11z/'z31 . RECEIVED NOV 03 2022 _ — .nw 4 Massaci”4.,ftc --. v; S?i___,DING DEPAR- ME {7 Permit No t z ,— a,ar&nsnf ol Jcrvt -T�_ Occupancy and Fee Checked •'. — - BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07] (ley„,blank) 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: pli,3it�'j�Ci or Town of: ARMOUTH To the Inspecoff' Tres: By this application the lmdersigned givesnotice of his or her intention to perform the electrical work described below. Location (Street&Number) ` �,L-�'�,1rf i _ �f Owner or Tenant &v 1 RJssC' V t � 7 1( 5; / -r'b;/) Telephone No. Owner's Address U.fj-•t''i e` Is this permit in conjuncFt•th a building permit? Yes J2 No 0 (Check Appropriate Box) Purpose of Building [-;r'' Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd 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: (�fkk jf feh fJ-0D117(', j jean 14 Completion of thejollawing table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of CeiL-Snsp.(Paddle)Fans Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool arid. ❑ grid. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners _ Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices icipa No.of Dishwashers Space(Area Heating KW Low❑ Connection ❑ Other No.of D ers Heating Appliances 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. H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: Y g No.of Devices or Equivalent OTHER: V Attach additional detail if desired.or as required by the Inspector of Wires. Estimated Value of Electrical Work: - (When required by municipal policy) imi Work to Start: Inspecti ns to be requested in accordance with MEC Rule 10,and upon completion. r 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 1-7 undersigned certifies that such c verage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER ❑ (Spec. �� t) r (t y. I certify, under the pains and enalties of perjury,that the information on t t�'ts a ffeadid' n is and comp` de. / 3 FIRM NA LIC.NO.: I Licensee: Signature , LIC.NO.: ?(„�t,) 1 (If applica l enter " t"i the license tuber Ii aa ,. Bus.Tel.No.: Ci . Address: �) 6 C� 3 j. (.P [ CA.�kf j\ Alt L/ Alt.TeL No.: 9 7(r7'7 cif_ j "Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety" License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally Q required bylaw. Bymysignature below,I herebywaive this requirement. I am the(check one) owner S q � �I ❑ ❑owner's agent ti Owner/Agent 1 Signature Telephone No. PERMIT FEE: $ f c;pC Vf*