HomeMy WebLinkAboutBLDE-23-15859 A Commonwealth of Massachusetts of Yam .
*u hTown of YarmoutId 0 „ k c:
ELECTRICAL PERMIT F'
Job Address: 45 CARRIAGE LN Unit:
Owner Name: DEAN CHARLES A TRS DEAN SUSAN J TRS
Owner's Address: 45 CARRIAGE LN Phone: Email:
Purpose of
Building Residential Utility Authorization No.:
Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15859
Existing Service Amps/Volts Overhead ❑ Underground❑ No.of Meters:
New Service Amps I Volts Overhead 0 Underground❑ No. of Meters:
Description of Proposed Electrical Installation: Replacement pool patio grounding grid.
No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type:
No. Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating:
No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA:
Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW:
No.Heat Pumps: Total KW: Total Tons: Fire Alarm System❑ No.of Devices:
Swimming Pool: In-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices:
No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices:
No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets:
No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices:
Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment:
No.of Modules: Roof-Mount❑ Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ Rating:
Estimated Value of Electrical Work: $ 3,000 Work to Start: May 17, 2023
FIRM NAME: License Number:
Master/System and/or Journeyman Licensee: HENRY LARKOWSKI License Number: 26990
Security System Business requires a Division of Occupational Licensure
"S" LIC. License Number:
Address: DENNIS, MA, 026380267 DENNIS MA 026380267
Email: henryjl1946@gmail.com Business Telephone: 508-776-7744
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.
INSURANCE:
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code,(MEC), 527 CMR 12.00
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4 :, ;= TOWN OF YARMOUTH
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�„� Fee: $
PERMIT NO.Ci:2-7 — t 58 9
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(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:
To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical
work described below. ' 71
Location (Street&Numbed ,,&E-1 &--_II
Owner or Tenant V Telephone No.
Owner's Address ,6 �=J 6 ".
Is this permit in conjunction with a building permit? 11 Yes C]No (Check Appropriate Box)
Purpose of Building <.,PCD6
Utility Authorization No.
Existing Service Amps / Volts OverheadC Undgrd 71 No. of Meters
New Service Amps / Volts Overhead Undgrd 11 No. of Meters
Number of Feeders and Ampacity llam,
Location and Nature of Proposed electrical Work: J"7C` _ t-- ��
Completion alike following table may be waived by the Inspector ofWire_s
i No.of Total
v` No. of Recessed Fixtures No. of Ceil.-Susa.(Paddle)Fans i Transformers KVA
JI No. of Li lutiiig Outlets No. of Hot Tubs I Generators KVA
Above In- {No. of Emergency Lighting
{ ra No. of Lighting Fixtures Swimming Pool gd. C] grnd. !Battery Units
I
No. of Receptacle Outlets 4 No. of Oil Burners FIRE ALARMS 1 No. of Zones
No.of Detection and
No. of Switches �No. of Gas Burners Initiating Devices
Total
No. of Ranges 1 No.of Air Cond. Tons No. of Alerting Devices
i i Heat Pump ? Number ! Tons -` KW No. of Self-Contained
qq‘1' No. of Waste Disposers Totals: —— i'— — ——— Detection/Alerting Devices
i Space/Area of Dishwashers
Municipal
` , Heating KW Local Connection Other
l- Secutity Systems:
No. of Dryers I Heating Appliances KW i No.of Devices or Equipvalent
No. of Water0
1 No.of No. of Data! Wiring:
Heaters KW i Signs Ballasts I No.of Devices or Equivalent
I !Telecommunications Wiring:
No. Hydromassage Bathtubs I No. of Motors Total HP r No.of Devices or Equivalent
�( Attach additional detail if desired or as required by the Inspector of Wires.
INSURANCE COVERAGE: Unless waived by the owner.no permit for the performance of electrical work may be issued unless the licensee provides
proof of Iiability insurance including "completed operation"coverage or its substantial equivalent. The undersigned ce lies that such coverage is in
Uforce, and has exhibited proof of same.to the permit issuing office.
Est4CHECK ONE: INSURANCE BOND C] OTHERCI (Specify`�C IT
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/ � � y ti
v LJ r, _� ( rg ration Date)
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imated Value.Elec 'cal Wor (When required by municipal policy.)
Work to Start' j `2 Inspections to be requested in accordance with MEC Rule 1G, and upon completion.
I certify, under e l s and penalties of perjury,that the information o this application is true and complete.
FIRM NAME- LIC. NO.
Licensee: — t �� Signature LIC. NO , 7,6 nI tf 0
(If applicab e tx k t" in hiSense nu line.) Bus. Tel. ?�'o.:
Address: — 1p It. Tel. No.:2� Yi Y-
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 ❑ owner's agent.fl
Owner/Agent