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Home My WebLink AboutE-19-1176 "^ 4 „ Commonwealth of Official Use Only ftirt Massachusetts Permit No. BLDE-19-001176 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rRev.I/07j APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEA SE PRINT ININK OR TYPE ALL INFORMATION) Date:8/28/2018 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) 5 GLENWOOD ST Owner or Tenant WACKROW JEAN M(LIFE EST) Telephone No. Owner's Address 5 GLENWOOD ST,WEST YARMOUTH,MA 02673 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: Replacement boiler. _ 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 1 No.of Detection and _.. Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons _— No. 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 ❑ Other: Connection No.of Dryers Heating Appliances KW 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.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 ❑ BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: WAYNE B SCHMIDT Licensee: Wayne B Schmidt Signature LIC.NO.: 33699 (If applicable.enter"exempt"in the license number line.) Bus.TeL No.: Address:222 WILLIMANTIC DR.MARSTONS MLS MA 026481929 Mt.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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 e( (� F _e_____ G k6:1 .alltdr eilliseb • y/j///q/ //�J . t�ommonwean o/It/aesachiwet1 /(fl e aI se Only / ,,, vii-=i c� giro [�Js Permit No. L/_q �y�� L. --a mu _[Jeparfmsnt of,}ire.-ervicee a.lIf , Occupancy and Fee Checked • \ y.. BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cocle,.(i'+f5G),527 FMR I�.IiO (PLEASE PRINT IN INK OR ALL INFOR ION) Date: S(() rOJwf 7 I\I 1 (OJ City or Town of: 1111/1101/ To the Inspector of Wires: By this application the undersign gives notice of his or her int tion to performtethe electrical(work described below. Location(Street&Number) 5 ex\1W, ('} O .i u W a y i7 celc Owner iorTenant 3:e—...CA—r\ U3Ctul.i -cej(AJ Telephone No. 7s7- OKca' Owner's Address -------- Is this permit in conjunction with a building permit? Yes ❑ No'$ (Check Appropriate Box) Purpose of Building 1)W_e•\\ \A!^ Utility Authorization No. Existing Service_ Amps : / Molts Overhead ID Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity r � catiLk)and Nature of Proposed Electrical Work: ) I rc '�cpL&c.e VNj.e,y‘jr 1Ler V Completion of the following table may be waived by the Inspector of Wires. otal No.of Recessed Luminaires No.of CeI.-Susp.(Paddle)Fans • Tra of Transformers KVA • KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. grad. Battery Units No.of Receptacle Outlets No.o rs FIRE ALARMS No.of Zones No.otSwitches No.of Gas Burners V No.of Detection and Initiating Devices No.of Ranges No.oI Air cond .Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons _TCW_ No.of Self-Contained P Totals: ' —• Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Local0 Municipal ❑ Other P Cyonnection No.of Dryers Heating Appliances KW Security No, f Devices or Equivalent ' No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent • No.Hydromassage Bathtubs No.of Motors Total HP Tei No.of Devices or Equivalent OTHER: • Attach additional detail if desired or as required by the Inspector of Wires. Estimated Valu civmL c rki (When required by municipal policy.) Work to Start: O� Inspections 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 BOND 0 OTHER 0 (Specify:) - I certify,under the pains and na s ofveriurr,that the Inform donon this l'anion{s true and comptetu�,^ rep? • FIRM NAME:_ WAYNESCHMIDT V5 (�—' LIC.NO.: s(O Licensee: ELECTRICIAN Signature `�J LIC.NO.: 222 WILLIMANTIC DRIVE g (Ifapplicable.ente MARSTONS MILLS, MA 02648 , Bus.Tel.No. 3Di 7 07/ Address. (508)428.7747 Alt.Tel.No.:J D / f *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)❑owner ❑owner's agent. Owner/AgentPERMIT FEE:$ Signature Telephone No.