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Home My WebLink AboutBLDE-19-003323 a 'C.\C Commonwealth of Official Use Only \6: Massachusetts Permit No. BLDE-19-003323 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:11/30/2018 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) 9 CAPT CHASE RD Owner or Tenant POUTAS BERNICE J TR Telephone No. Owner's Address BERNICE J POUTAS TRUST,9 CAPT CHASE RD,SOUTH YARMOUTH,MA 02664 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 ❑ Undgrd 0 No.of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install receptacles for washer/dryer. 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 KYaC No.of Luminaires Swimming Pool Above 0 In- ElNo.of Emergency Lighting VT"? 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 0 Municipal ❑ Other: Connection No.of Dryers 1 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 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 (If applicable,enter"exempt"in the license number(ine.) 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone,No. PERMIT FEE:$75.00 P-St-Yral `F'I ' /9119 e ,.k reiticake . • Conunoamea&of rr/aaaactta Official Use Only 2 r ' t� �s Permit No. .�"37'Z / -LJepartauat of Jinn Service; S. BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/0+7)' (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Al work to be performed in aceordanfe with the Massachusetts Electrical Code s7// 12.00 (PLEASE PMNT IN INK OR 7E ALL INFO�R;� ION) Date: ii i�( City.or Town of: '}M(j U 1K. To the Inspector of Wires: By this application the undersigndgives notice of his r her intention o rform the electrical work described below. Location(Street&Number) Ct �. A,D Q S nY�II( , /,3�� Owner•orTenant� h ILA M AIL I' Telephone No. 6, It_ 'Q�'/f Owner's Address S'� e • (J f(7 s Is this permit in conjunction with a guilding permit? Yes 0 Na kr: (Check Appropriate Bos) Purpose of Building Dj�'�\•\ t _ Utility • ithorizationNo.. - _ 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 • • of :tion an Nature Proposed Electrical Work: W t_ L/CJ`LS • (I' i =� ee 's t Furl- tr( - , " Completion ofthefollowingtable may be waived by the larpectorofWirer. No.of Recessed Laminalres No.of CeILSus a.(Paddle)Fans No,of '[rotal TransformeKVAVA No.of Luminaire Outlets No.of Hot Tubs Generator. KVA • ,AboveIn-- No.of*emergency Lighting No.of Luminaire •• ' Swimming Pool grnd : ❑ Rrwd. la Battery Units . • • No.of Receptacle Outlets No.of OB Burners _ FIRE ALARMS No.of Zones No.otSwitcheBurners No.of Gas No,of Detection and Initisting:Devit:ts No.of Ranges No.of Air Cond. .Tonsl No.of Alerting Devices No:of Waste Disposers Heat Pump Number Tons (KW No.of Self-Contained • Totals: • . 1 Detection/Alerting Devices No.of Dishwashers • Space/Area Heating KW- Local Q Munnn)cectipialon 0 Other Co 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 Equivshnt No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicationss ping: No.of Devices or Equivalent OTHER: Attach additional detail if desired.or as required by the Inspector of Wires. Estimated Value of Iec(4,�c y`oy k: (When required by municipal policy.) Work.to Start: I I� 1 1() Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CpppOOO1111��yyyyERAGE: 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 ❑ OTHER 0 (Specify:) I certify,nes • - the information on this application is true and complde„�� FIRM NAt WAY EEC SCHMIRICIAN T LIC.NO.:��ii ELECTRICIAN ��j�/2gt Licensee: 222 WIWMANTIC DRIVE Signature LIC.NO.: (Ifapplicabi. MAR • (508)MIL8-7 47 02648 7 217 1 428-7747 •rgjCfQus.Tel.No: vim,/ 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,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent Owner/AgentPERMIT FEE: S Signature Telephone No.