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Home My WebLink AboutE-19-1542 * a Commonwealth of Official Use Only iysiMassachusetts Permit No. BLDE-19-001542 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.l/071 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:9/13/2018 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) 20 FORSYTH AVE Owner or Tenant LPKI LLC Telephone No. Owner's Address 350 LINCOLN ST,HINGHAM,MA 02043 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Two split NC units&two baseboard heaters in basement. 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 I No.of Luminaire Outlets , No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- I:1No.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. 2 Total No.of Alerting Devices Tons 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 2 KW Security Systems:* 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 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: WAYNE B SCHMIDT Licensee: Wayne B Schmidt Signature LIC.NO.: 33699 7fapplicable,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,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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$80.00 rec g) Ci<GYac_____LCc . /�J ''`` l.oauaoameald Massachusetts of///assac tts Official Use Only cc�� 77 ((77 na Permit No. JJererfassa/el yin Jet>iceS _{Il-, Occupancj`andFee Checked ,. BOARD OF FIREPREVENIION REGULATIONS [Rev. 1/07) (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perfoimed in accordance with the Massachusetts Electrical Code 527 CMR 12.00 (PLEASE PRINT IN INK OR 'EALL INFORMATION) Date: 9 !{{ City or Town of: Ary kr To the Inspector of Wires: By this application the undersign-, gives nod. -f his or ention to . dorm the tie •'cal wp work des �bAcl, , o�'. 1 Location(Street& umber) ia.0 ( &�m\ ' II ... I N 1 V� l(N 11i' `r„�'JJ Owner'orTenant ., f re,11 I h V\ Telephone No. Owner's Address SCK • Is this permit in conjunc '.n with a building permit. Y-. III No (Check Appropriate Box) Purpose of Building :broA t%=�at► Po g _>ir3" �'L1' I .)) i r�tt�Autborization No. Existing Service - Amps - / Volts I- rhead 0 Undgrd 0 No.of Meters • New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters• _ Number of Feeders and Ampacity • — Location an. •ature of Propos . Electrical W.rk: ��• ',moi a U1i lit 1��r�a�•��' 0 it Ai 1`k ..I t�tit'�%� / I sT. r is:Iac�ii%�i �.V/,�111i( Completion ofthe follawing table may be waived by the InspectorojWirer- No.of Recessed Luminaires No.of CeB-.Snsp•(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swimming pool-Above 0 in. No.of hsmergency Lighting ' . pool:Ably?. grad. 0 BatteryUnits • No.of Receptacle Outlets No.of OB Bunters FIRE ALARMS No.of Zones No.of Switches No.of Gas Bunters No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No:of Waste Disposers• Hat Pump Nom r Tons KW No.of Self-Contained Totals: Detection/AlertingDevices •No.of Dishwashers • Space/Area Heating 1 v •V'° t " xi p Mimics.* Omer �,y Conriei:tlon No.of Dryers Hating Appliances loy f`�j)GQ,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 o Elec r-cal ork: (When required by municipal policy.) Work.to Start: dir a Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C 1 RA E: 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 co erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I cerkfy,ut " the information on this application is true and complete. �� FIRM NA1 WAYNE SCHMIELECTRICIAN T LIC NO.:r✓i ELECTRICIAN Licenser. 222 WILLIMANTIC DRIVE Signature LW.NO.: Irce:- MARSTONS MILLS,MA 02648 afappAddy • (508)428.7747 Bus.Tel.No.�2("/' • Address. • Alt.Tel.No.., '/ *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.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.1 hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $