The URL can be used to link to this page

Home My WebLink AboutBLDE-19-001177 a' Commonwealth of OfficialUse Only /S Massachusetts Permit No. BLDE-19-001177 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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 (PLEASE PRINT IN INK 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 pertorm the electrical work described below. Location(Street&Number) 72 COLLINGWOOD DR Owner or Tenant CLARKSON DAVID F Telephone No. Owner's Address CLARKSON CECELIA T,72 COLLINGWOOD OR,YARMOUTH PORT,MA 02675-1509 Is this permit in conjunction with a building permit? Yes 0 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: Disconnect 220 volt range line&install receptacle. Completion of the following table may be waived t e Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 'No.of L/ Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs 'Generators KVA I No.of Luminaires Swimming Pool Above ❑ Io- ❑ .No.of Emergency Lighting grnd. grnd. ,Battery Units No.of Receptacle Outlets 1 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 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 ❑ 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 Stens 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 (Ifapplicable,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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 ,fi,C4‘94.) CI<C4rigt51C/ . ' • Cn �/ yyyy on$nomosaJJ of/r/assachaxl s Official all Use /Only s..-. 00,.--a., Permit No. �7 Semite; .. ;.�:,11� 3 slrarlw�n[Of Jin. e,,t' 3 4 • ;. :• .. ' ..•. Occupancy and Fee Checked • - '• `s BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07) ' (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordase with the Massachusetts Electrical Code 12.00 (PLEASE PRINT IN INK ORTyP 4LLINnFAORI�IV) Date: g i City or Town of: ` tom\(1` ' ' ` Q,J To the Inspector o Wires: By this application the undersign y es noseic ,oaf is�or a intention to r� dorm electrical work described below. Location(Street&Number) \ `\ _ 30. Owner'or Tenant CC.- a ,s at . AA Telephone No. ; 1— 2 Owner's Address • �e Is this permit in conjunction with a building permit? Yes 0 No (Cheek Appropriate Box) Purpose of Building Utility Au{horizatlon No. Existing Service_ Amps . I Volts Overhead 0 Undgrd❑ No.of Meters • New Service _ Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampaeity �. Location�d Nature of Propo'dml ical Work:�- � 12-0‘j ` / o , f, {{��_as La a h. 4(/ Da -e-- \ fwfrseul• r �l PIM �� fes,�// is(Smpole) ajthrjoft•. 7. ' gray be :rued by the fTotalroJii"nvs. Na.o ased m a r f(o.of Ceil usp. die)Fans No.o Total KVA _ ' No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Lomlaatres Swimming Pool Above In- No.of Emergency Laghung - . grad.. 12-I 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 Total g No.of Air Cond. .Tons No.of Alerting Devices • Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices . No.of Dishwashers • Space/Area Heating KW Loral 0 Municipal Connection 0 Other No.of Dryers Heating Appliances KVV Security Systems:* Devices or Equivalent No.of Water KW No.of ('(o.of Data Wiring: • Heaters Signs Ballasts No.of Devices or Equivalent • No.Hydromas age Bathtubs No.of Motors Total HP Telecommunications Wiring: pick �� AV�,�} _,e - 1 j/�y1�'�N�o.of Devices or Equivalent \J` ,I�,/r ler Attach additional dna: tti esid "re4 oras requi3lbge Inspector of Wires. V Estimated Valu Enke 'cal Worki (When required by municipal policy.) Work to Start: d-/,4 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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,trooffice... d has exhibited proof of same to the permit issuing oce. CHECK ONE: INSURANCE BOND 0 071IER Q (Specify:) /certify,ur ' the information on this application is true and complete.. A�� FIRM NAI WAY C SCHMIT f fI� +fi+ 5 ELECTRICIAN 1, �y�� `-�\w(�O LIC.NO.: Licensee: 222 ONS MILLS, DRIVE signature��ps U LIC.NO.: pjapplicabl. MARSTONS MILLS,MA 02648 Address: ) • • (508)428.7747 Bus.Tel.No: Alt.Tel.No. �� 1/ "Per M.G.L.c. 197,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,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$