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Home My WebLink AboutBLDE-19-000800 "' ar Commonwealth of Official Use Only E` `' Massachusetts Permit No. BLDE-19-000800 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 PRINTIN INK OR TYPE ALL INFORMATION) Date:8/9/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. Location(Street&Number) 6 COPPER BROOK RD Owner or Tenant SUROZENSKI ANTHONY R Telephone No. Owner's Address SUROZENSKI ALICE L,6 COPPERBROOK RD,SOUTH YARMOUTH,MA 02664 Is this permit in conjunction with a building permit? Yes El 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: Generator 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 1 KVA 11 No.of Luminaires Swimming Pool Above ❑ ln- CINo.of Emergency Lighting grnd. grad. 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 Initiation 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/Alerting Devices11 No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection N No.of Dryers Heating Appliances KW Security Systems:* 1 No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail it 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 ofperjury,that the information on this application is true and complete. FIRM NAME: WAYNE B SCHMIDT Licensee: Wayne B Schmidt Signature LIC.NO.: 33699 of applicable,enter"exempt"in the license number line.) Bus.TeL No.: Address:222 WILLIMANTIC DR, MARSTONS MLS MA 026481929 Alt.TeL No.: 'Per M.G.L.c. 147,s.57-61,secunty 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 oPA___a /zt /(s Ke-- re. 41) cl<GI:In2_, . Ituir l�oaanasloia of/r/W:fac fi! r�J$I Use & ( ) —u S✓:= cc�� °P �i Permit No. �\ . •Ill= Therarimat of Jiro Jerrica -i�il= Occupancy and Fee Checked BOARD OF ARE PREVENTION REGULATIONS [Rev.I/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical � CMR 12.00 (PLEASE PRINT IN INK OR TIP L INFORMA ) Date: P/ Ip ► 1 527(off City or Town of: o' To the Ins ector of Wires: By this application the undersign gives notice of his or her'-ef" - A tion to perfo lY electrical work described below. . Location(Street&Number) • $ • v w' : S a r Ownefor Tenant...I-n[4 y 0 �� a t Telephone No. WM - IIS ,. Owner's Address (( - ^ ^� oa Is this permit in conjun on with a b ing permit? Yes 0 No (Check Appropriate Box) �31/, Purpose of Building V V Fe, Utility Au orhation No. Existing Service • Amps - / Its Overhead 0 Undgrd 0 No.of Meters - New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Loc ion and Nature of roposed Electrical Work: tt (- Y\ p .Ithejol. •• ,g, •.!� • 4 waived by the Inspector of Flirts. No.of Recessed Luminaires No.of Cet-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Ldminatres .i Swimming Pool Above 0 In- No.of Emergency Lighting - • . grad.. grad. 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 No,of Devices •Tons g No.of Waste Disposers 'Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertiig Devices . No.of Dishwashers Space/Area Heating KW Local0 Municipal 0 otlrer C No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent KW No.of No.of Data Wiring: Heaters Ballasts 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 oras required by the Inspector of Wires. Estimated Valu t : •'c. s, ki (When required by municipal policy.) Work to Start: al % % Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O • • GE: 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 0 OTHER 0 (Specify:) I certify,ur - the information on this application is tree and completc��A�� FIRM NA! WAY EEC SCHMIRICIAN T LIG NO.: ►►T�ii++ 55 ELECTRICIAN � Licensee 222 WIWMANTIC DRIVE Signature LIC.NO.: MARSTONS MILLS.MA 02648 Qjapplimb! (508)428-7747 • Bus.Tel.No.•ir/OQ'7'j7 217) Address: - Alt.Tel.No.. �7( *Per M.G.L.C. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$