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Home My WebLink AboutBLDE-20-000374 Commonwealth of Official Use Only 0Massachusetts Permit No. BLDE-19-006518 \— BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' [Rev.1/07] 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 PRINT IN INK OR TYPE ALL INFORMATION) Date:5/17/2019 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) 2 PRESTON WAY Owner or Tenant SAMOLEWICZ JOAN K Telephone No. Owner's Address 18 COOLIDGE AVE, NORTHAMPTON, MA 01060 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: Split A/C 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 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 Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 1No.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 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 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: $50.00 e)k 1 /3 /t ) (eg--- keg LAN,e.,564, , tlt,Lt ry� / Official Use Only Commenswrealth a f�/Iaaachudefil t i Permit No. e_":k-le S t • •�1 .Uep wIm n1 o f a2/re Services . • `; i F a' • " • •• - Occupancy and Fee Checked '. • • BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK MI work so be performed in accordance with the Massachusetts Electrical Code(MEC)..527 CMR 12.00 (PLEASE PRINT IN INK OR TYP LL FORMA Date: .5- I E 3 tlC( City or Town of: 0 0 To the Inspector of Wires: By this application the undersig d gi ice of hi r her intention to perfopm the electrical work described below. Location(Street&Number) Tole i. A -.V, CAT \s Lt l 3••— Owner'or Tenant"eo001\ S Pylvk O e w l C. { Telephone No. 53 6 __ 5 _ Owner's Address ,,...con Is this permit in conjunct with abuilding permit? Yes 0 No O. (Check Appropriate Box) Purpose of Building P �'L t�VA.,...3 Utility Authorization No. Existing Service Amps • / Volts OVerhead❑ Undgrd 0 No.of Meters • New Service Amps / Volts Overhead 0 Undgrd El No.of Meters Number of Feeders and Ampacity , Location and Nature ef'Proposed Electrical Work: (.,A.._.) t 1 �9 (/\4 k-�v\6 .` frc, ____ s-y s_ i m . . , Completion of theforlowing table may be waived by the bopectorof Wires_ No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans Wo.of To Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • •No.of Luminaires Swimming Pool grnd e r rt frnd1 ❑ Battery Unit No.of s ncy ugnttng ' ' No.of Receptacle Outlets No.of 011 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 Alertin Devices Tons No. g No.of Waste Disposers Hai Pump Number Tons KW of Self-Contained ' Totals: • "`,Detection/Aler lhg Devices No.of Dishwashers Space/Area Heating KW Local Q Municipal ❑ Other Connehtion No.of Dryers Heating Appliances KW ances Security Systems:* i No.of Devices or Equivalent No.aWater KW No.of No.of 'Data Wiring: • Heaters S_ ighs Ballasts I No.of Devices or Equivalent • 3 - Telecommunications Wiring: No.Hydrom�ge Bathtubs • No.of Motors Total HP �- No.of Devices or Equivalent, OTHER: `3J ot4 �T�S •1 Lad C,US Iola iN( ti =�c/JI r`el �� d Ana.h additional detail If desired.or as required by the Inspector ofli s. Estimated Value o Elec ical Work: (Wh required by municipal policy.) JI Ole, Work.to Start- Inspections to be requested i accordance with MEC Rule 10.and upon completion. +114y INSURANCE COVERAGE: Unless waived by the owner,n permit for the performance of electrical work may issue unless the licensee proyides proof of liability insurance including"co plated operation"coverage or its substantial equivalent. The undersigned certifies that such co erage is in force,end has exh .ited proof of same to the permit issuing office... CHECK ONE: INSURANCE .BOND 0 OTHER 0 (Specify:) I certify,us ' " "tat the inf rmation on this application is true and complete. � /'' FIRM NA1 WAY SCHMIDT LI C.NO.: 1p9�ELECTRICIAN Licdnsee: 222 WILLIMANTIC DRIVE g; natn LIC.NO.: (lfoppsee:- MARSTONS MILLS, MA 02648 g • (508)428.7747 Bus.Tel.No.;1/V "] j iAddress: I Alt.Tel.No,, f�..1/ 0%1 i *Per M.G.L.c. 147,s.57-61,security work requires Departm t of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Li.ensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this r uirement. I pm the(check one)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:Z d