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Home My WebLink AboutBLDE-23-005647 4ar . Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-005647 �-' 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:4/11/2023 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) 45 CARRIAGE LN Owner or Tenant SUSAN DEAN Telephone No. Owner's Address 45 CARRIAGE LANE, 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 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: Remove wiring &receptacle for stove in pool house. 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. Total No.of Alerting Devices Tons 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 ❑ 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 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 ❑ 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 ae q( f3(Z3 i I N.' [ . CEVED I .1 Conlrnonwaa �-;-: - ,._. a ri/aaeac�iuealte Official Use Only R 10 2023 1-7 • y cal Permit No,�2�— ç L\ .41 -• :1 •-� of o 3irs �iwic.e i PARTMEN�1 NG� u OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked '' [Rev. l/07J �. -�� - (leave 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 rg (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / Cityor Town of: - `/i4` YARM�UTH To the Inspector of Wires: lay this application the undersigned 4v notice_of his or her intention to perform the electrical work described below. LocationLZ (Street& Number) i e-P-�� /rc L. / Owner or Tenant j — <��-,r ` i 't_ 1 l ----�: .�,1 Telephone No. ,.1 Owner's Address Sc7- Is this permit in conjunction with a building permit? Yes ❑ No Check Purpose of BuildingI-7 K ( Appropriate Box) i Utility Authorization No. el i abating Service Amps / Volts Overhead ❑ Undgrd g 0 No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters k ./ Number of Feeders and Ampacity k Location and Nature of Proposed Electrical Work: a r 1 No. of Recessed Luminaires Completion of the followingboleo uy be waived by the Inspector of Wires. No.of Ceil:Sasp. (Paddle) FansNA {r Transformers KVA Lb Kyq ev �1 No. of Luminaire Outlets No.of Hot Tubs r� Generators KVA Above ❑ In- 'No. of Emergency Lighting , ' No. of Luminaires - Swimming pool grnd. grad. ❑ 'Battery Units '�' No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo. of Zones t. No. of Switches No. of Gas BurnersNo. of Detectrn and i+ Initiating Devices y No. of Ranges No.of\Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposes Meat Pump Number Tons I KW No. ofSelf-Contained Totals: I_ Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal , No. of Dryers HeatingAppliances Connection ❑ Other PP KW security Systems:* ' No. of Water No. of No. of Devices or Equivalent Heaters ' No, of Data Wiring: Si ns Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecotnmun ons r OTHER: No.of Devices or E uivalent , Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value 7lectiicai WorkWork to Start: (Whenrequired by municipal policy.) 3 Inspections to be requested in accordance with MEC Rule 10, and upon com letiINSURANCE E GE: Unless waived by the owner, no permit for the performance of electrical work mayissue the licensee provides proof of liability insurance including "completed operation"coverage or its substantial equivalent lsue unless undersigned certifies that such coverage is in force, and has exhibited proof o to thepermit issuing The CHECK ONE: INSURANCE BOND 0 OTHER office. I certify, under the pains and Penalties o 0 (S cif' is G - U J6 3 CO3t42 FIRM NAME- LIC. that the information on ap�icait is true and complete. Licensee: .� r, LIC. NO.: (Iffapplicab . " r in the ' ense nun, Jlgnature LIC. NO.: Address: AS t I Bus. Tel. No.`,_ *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: — OV1'1�IER'S INSURANCE WAIVER: I am aware that the Licensee does not have Alt. Tel. No.: y Lic. No. required by law. By my signature below, I hereby waive this requirement. I am the (check one the liability insurance coverage normally Owner/Agent owner Signature � owner's a:ent. Telephone No. PERMIT FEE: $