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HomeMy WebLinkAboutBLDE-19-002317 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002317 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:10/18/2018 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 CS all work describe Location(Street&Number) 32 JOHN HALLS CARTPATH VI `t'J vb !vr Owner or Tena Telephone No. Owner's Address 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 0 Undgrd 0 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: Replacement HVAC 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 1 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: 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 'v?A- (c 20! • OA 4/4 0? 02_,b §r01(<11 .ree-----C-6 c.kill__2_3_,sj- �r. Commonwealth oil Vassacitusalts Official Use Onl ='��= cc�� c Permit No. cp-7-i, I r7 lff1= = Jiepar/mad o f giro-Y -I y -• 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 CI . 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: 10 11 City or Town of: YARMOUTH To the Inspector of Wires: By this application the lindersi d •,ives no cr,„o his or her i tention to perform e electrical work described below. Location(Street& ber) � Owner or Tenant v I f - Telephone No. Owner's Address -'--MtL Is this permit in conjunction with a[Tiding permit? Yes ❑ No1%1 (Check Appropriate Box) Purpose of Building D W \\ f �� Utility Authorization No. Existing Service Amps / Volts Overhead ❑, Undgrd❑ No.of Meters New Service Amps - / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity • Lo tion and Nature of Proposed Electrical Wor -� Iiscs 'f u r N ►tre 71- pletion 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- ❑ fNo.of 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 Total r- - No.of Ranges No.of Air Cond. � Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number ors KW No,of Self-Contained Totals:I -�`--_ Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Municipal Local❑Connection Other No.of Dryers Heating Appliances KW Security Systems:* No.of Water No,of Devices or Equivalent No.of No. of Heaters KW Ballasts Data Wiring: Signs No.of Devices or EquivalentNo. Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Cfr\\ Atta h additional det if desired or as requir by the Inspector of Wires. Estimated Val of e ' W k: (When required by municipal policy.) CuslOrieffi'�itii� (� Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. " �J 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 isss�uing�ooffice. CHECK ONE: INSURANCE X BOND ❑ OTHER X(Specify:) ( Jo cK rs ��''in [ I certify, under t` -"- -- -%-- - • y that the information on this 4 icati,n is true and complete. FIRM NAME: WAYNE ELECTRICIAN SCHMIDT p --qaq / LIC.NO.:-- �—)��� Licensee: 222 WILLIMANTIC DRIVE r, , —MARSTONS MILLS, MA 02648.—_Signatu LTC.NO.: (If applicable,ente (508)428-7747 'ne.) Address: Bus.Tel.No.:2171 J "`Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lic.No. -- OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally S required by law. By my signature below, I hereby waive this requirement I am the(check one)0 owner ❑owner's agent. 7 Owner/Agent 1 __ LA Signature Telephone No. I PERMIT FEE: $