HomeMy WebLinkAboutBlde-20-002607 Commonwealth of Official Use Only
Massachusetts Permit No. BLDE-20-002607
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:11/5/2019
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) 193 CAMP ST
Owner or Tenant DAVENPORT DEWITT TR Telephone No.
Owner's Address DAVENPORT REALTY TRUST,20 NORTH MAIN ST, 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 0 Undgrd ❑ 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: Replacement furna,, x `�'
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. 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 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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_:---- c� c7 Permit No_ L--o Z6c)7
`ail= _ 2)e arfinent o/.}ire Services
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`= ' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] ((cave blank)
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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 INFOR 011� Date: . to[a ! i-!
City or Town of: 'O U1�� To the Inspector of Wires: -
By this application the undersign Aiy,5 notics or her rote lion to perform the tyycal described below. ya....___
Location(Street&Number) VY. r7 �1�
Owner-or Tenant De‘\}.(-'A C!CT Telephone No.
Owner's Address
Is this permit in conjuAtkon with a building permit? Yes ❑ No 1 (Check Appropriate Box)
- --
Purpose of Building k/Nsi` 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 ^
Location and Nature of Proposed Electrical Work: (A) 1_ <_p L —C e r1-e11/
C9--Yli-J rtirn ke_-I . Tevc +a cue r. -
Completion of the followinKlable may be waived by the Inspector of Wires.
No.of Total
No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
Above In- No.of Emergency Lighting
• No.of Luminaires Swimming Pool grnd. ❑ grnd. [1 Battery Units _
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Gas Burners No.of Detection and
No.of Switches Initiating Devices
° No.of Alerting Devices
No.of Ranges Tons
Heat Pump Number Tons KW No.of Self-Contained
No.of Waste Disposers Totals: — Detection/Alerting Devices -
Municipal
No.of Dishwashers Space/Area Heating KW- Local Connection ❑ Other _
HeatingAppliances KW Security Systems:*
No.of Dryers pp ; o.of Devices or Equivalent .
No.of Water No.of No.of Data Wiring:
Heaters Signs KW _ No.of Devices or Equivalent •
.Telecommunications irin :
No.Hydromassage-B�a?thtubs '/ No.of Motors Total
H7P t No.ofDevrces or urvaheAnt
OTHER: cs-a\s � 9�Y e� lv 0 v T e p I1 y-
Jc r ' y the Inspector of Wires.
Estimated Value o Elec ical Work: �' (When required by municipal policy:)
Work to Start: 1,.1 I U t4 Inspections 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 cov :ge is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE is BOND ❑ OTHER ❑ (Specify:) •
I certify,under the pains and of perjury,that the inform . n.on this 'anon true and complete. 33
�• 7
FIRM NAME: WAYNE SCHMIDT LIC.NO.: (�
ELECTRICIAN Signature LIC.NO.:
Licensee: 222 WILLIMANTIC DRIVE _ 1'
of applicable.ente.MARSTONS MILLS,MA 02648 , Bus.Tel.No.:5/)� 7370 71
Address: (508)428-7747 Alt.TeL No.: VV
*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)❑owner ❑owner's agent.
Owner/Agent PERMIT FEE:$
Signature Telephone No.