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1 Commonwealth of Official Use Only
Lei Massachusetts
Permit No. BLDE-20-000372
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:7/22/2019
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) 18 CONWAY DR
Owner or Tenant MCCARTHY CHARLES J Telephone No.
Owner's Address MCCARTHY MARY WYSE,43 GARDEN ST, MILTON, MA 02186
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 system.
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/Alertinc Devices
No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 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:
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) 0 owner 0 owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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Commone/ea/tA o/Masdaeieudelid fficial Use Only
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r�=__ 2leparlment �J S Permit No. 3��
o f Jiro Serviced
{ Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07]
(leave blank)
APPLICATION .FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code C), C 527 MR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: - is' i ) C
City or Town of: YAR1VIOUTH To the Inspector of Wires:
. By this application the tmdersi d i s no ' e of his or her intention to perform the electrical work described below.
Location(Street&Number) Wia-• r - "Per
Owner'or Tenant e PA ar11. •
Telephone No. 3$
Owner's Address SP--fpv.L
Is this permit in conjunction with a bui)ding permit? ❑ Nolei (Check Appropriate Box)
Purpose of Building D W \` ,n Yes\ 1 _ Utility Authorization No.
Existing Service Amps / Volts Overhead ❑, Undgrd g ❑ No.of Meters
New Service Amps / Volts Overhead 0 Undgrd I; ❑ No,of Meters
Number of Feeders and Ampacity
Lq,c,gtion and Nature of Proposed Electrical Work: I UJ6-C VIICIS(}rJ
6 Irl. . __,6 ,
u 3 STC PI
Completion of the followinvable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ca-Stun.(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.o1 Emergency Lighting
• Ernd., 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. t TO-ta
Tons No.of Alerting Devices
•
No.of Waste Disposers Heat PumpTNumberons _ No.of Self-Contained
Totals: �i'' Detection/Alerting Devices
No.of Dishwashers Space/Area HeatingKW' Municipal
Local❑Connection �!�
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of Devices or Equivalent
No.of
Heaters KW of Data Wiring:
Signs Ballasts No.of Devices or Equivalent
No. Hydromassage Bathtubs N0.of Motors Total HP Telecommunications Wiring:
I_ No.of Devices or Equivalent
OTHER:
Attach additional detail y-desired or as required by the Inspector of Wires.
Estimated Value o Electrical Work: (When required by municipal policy.)
Work to Start: p� Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE VE GE: Unless waived bythe owner,no permit p rmit 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 X BOND ❑ OTHER X(Specify:) (I.)IJ cKe -s C" ' 1
I certify, under t'- --_ - -
WAYNE SCHMIDT y,that the information on this icati n is true and cantplete6q
FIRM NAME:- ELECTRICIAN l
222 WILLIMANTIC DRIVE A 1(� LIC.NO.: _C1
Licensee: ----MARSTONS MILLS, MA 02648_.__ g //"��
(If applicable,ente Sl Wahl LIC.NO.:
Address: (508)428-7747 ne.) Bus.Tel.Na.
J '`Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.Tel•No.•� �'��
— OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragerage normally—
S required by law. By my signature below,I hereby waive this requirement. I am the(check one)El owner ❑owner's agent.
7 Owner/Agent
j Signature Telephone No. I PERMIT FEE: $