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Home My WebLink AboutBLDE-19-006518 a Commonwealth of Official Use Only Massachusetts 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 ❑ 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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Split NC 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/Alertine 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 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 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 ere) Al(9p (eg_ ifeciagl_ LAN2e_564,_ . Cornrnonwaat.LL of///aosac ti4 Official Use Only )ti P t �a Permit No. t��`L � l g �� 5epori w ri of L Jerrdeea . . .• i ' ' • • " • •• . Occupancy and Fee Checked .. ' • • ,,� BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in aceordani a with the M achusetts Electrical Code • _527 CMR 12.00 (PLEASE PRINT IN IiW OR TYP LL NFORMA :i Mite: S- 1 (3 t IC( City or Town of: 0 O To the Inspector of Wires: By this application the undersig d gi vw ice of hi r her mt, tion to perform the electrical work described below. Local-kin(Street&Number) C- Y\ • J (,4 PIE' Lt 13` Owner'or Tenant iQO Y\ 3PrIvk 0 1k.LU 1 ' 1 Telephone No. 53 6 - 5 LIU Owner's Address • •..‘ Is this permit in conjunction with a uilding permit? s 0 No igf (Check Appropriate Box) Purpose of Building Utiliti Authorization No. • Existing Service Amps • / Volts OV rhead❑ Undgrd 0 No.of Meters • New Service Amps / Volts Ov.rhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Natu c Qf Proposed Electrical Work:. . ` l V ..C�U Y-� �` Yc_ s-ys _sew Cqm,/coon of the forlowin table my be waived by the bupeetoroLWires No.of Recessed Luminaires No.of Ceii.-Susp.(P., 'dle)Fans of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Ltiminatres Swimming Pool•4 n' • ,, e Q irndt Battery Units sency Lighting No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.ofSwitches No.of Gas Burners No. • of Detection and Initiating.Dgviees No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons • No.of Waste Disposers Host Pump Niumibe Tons KW No.of Self-Contained ' Totals: • M` Detection/Alec ng Devices No.of Dishwashers Space/Area Heating KW' Local Q Municipal ❑ Other Connection No.of Dryers Heating Appliances Key t Security Systems:* No.of Devices or Equivalent No.of Water � KW No.of No.of Data Wiring: Heaters Ballasts No.of Devices or Equivalent • No.Hydromassage Bathtubs No.of Motors Total HP eieco of Deviations Wiring _ _ No.of Devi es or Equivalent T tt,, ll OTHER: •JC Ivy_ .S ��.;,.: :J C.0 T(i r i t Y� title Atta.h additional detail if desired,or as required by the Inspector o • v. Estimated Value o Elec ical Work: (Wh required by municipal policy.) �.1+ Vile, Work to Start. Inspections to be requested i accordance with MEC Rule 10,and upon completion. +CR;ly INSURANCE COVERAGE: Unless waived by the owner,n.permit for th performance of electrical work may issue unless the licensee provides proof of liability insurance including"co pleted operat' n"coverage or its substantial equivalent. The undersigned certifies that such co erage is in force,qnd has exh bited proof o same to the permit issuing office... CHECK ONE: INSURANCE .BOND 0 OTHER 0 (Specify:) I certibt,us " ' • ''tat the inji rmation on this application Is true and cosnpletg. FIRM NM SCHMIDT LIC.NO.:.533‘99 ELECTRICIAN Licensee: 222 WILLIMANTIC DRIVE SignaturQAJT LIC.NO.: Licensee:- MARSTONS MILLS,MA 02648of _ (508)428.7747 Bus.Tel.No.:•t t3.7� �I t • Address: Alt.Tel.No.a--A)�J ffJJ i "Per M.G.L.c. 147,s.57-61,security work requires Departme t of Public Safety"S"License: Lk.No, OWNER'S INSURANCE WAIVER: lam aware that the Licensee does nth have the liability insurance coverage normally required by law. By my signature below,I hereby waive this r..uircment. I am the(check one)❑owner 0 owner's agent. Owner/Agentj Signature elephone No. PERMIT FEE:$ L5d