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Home My WebLink AboutBld-21-005882 4/iP Commonwealth of Official Use Only r Permit No. BLDE-21-005882 , Massachusetts 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:4/13/2021 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 ROADS END Owner or Tenant GABRIELS JEFFREY K Telephone No. Owner's Address GABRIELS JO ANNE TAYLOR, 299 ELLIOT RD, EAST GREENBUSH, NY 12061 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: Replacement furnace&add on 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 1 No.of Detection and Imtiatine 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 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 ❑ 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 ( c z, L:7 ckG-:_ay_o_c____ F-es,-5D . Commontvsa/tL o/ adcac�ft Official Use Only �� - cc�� c�'77' Permit No. i�' (D Z- - / tI= = Aparfinant of yire Serviced • --r' 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)/527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: t / ) j City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned giv5notice of his or her intention to perform the electrical work described below. • Location(Street&Nut._ er) _ ( Ej' j, S.y • Owner or Tenant 'e. ' -Ili � C Telephone No " / r Owner's Address .'-- L t -� Is this permit•in conjunction with a bui)ding permit? Yes E No Igl (Check Appropriate Box) Purpose of Building D W L \\ V\ Utility Authorization No, Existing Service Amps / Volts Overhead D. Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity • LoAtion and Nature of Proposed Electrical Work: • Completion of thefollowinztab a may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA • No.of Luminaires Swimmin Pool Above In- No.of Emergency Lighting g ernd. LJ-grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS !No.of Zones No.of Switches No,of Gas Burnersc). -No.of Detection and - Initiating Devices No.of Ranges No.of Air Cond. Tons 4\,l . No.of Alerting Devices No.• of Waste Disposers Hat Pump Number Tons KW No.of Self-Contained Totals:I '"�""""`"" Detection/Alertin�Devices No.of Dishwashers 'Space/Area Heating KW' Local 0 Municipal 0 Ot>ner, Connection No.of Dryers Heating Appliances KW security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: ` Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: - No.of Devices or Equivalent OTHER: W��,) �A,� GJ Done_ • . 1 Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value o`fEl � El �Work: (When required by municipal policy.) Work to Start 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 coverage is in force,and has exhibited proof of same to the permit issuing office.ONE: INSURANCEWJ BOND 0 OTHER X(Specify:) o CKerS CO' [ I certify,under 1'------- ----'-----"-- WAYNE SCHMIDT y,that the information on this icati n is true and complete. FIRM NAME:- ELECTRICIAN l LIC.NO.: � Licensee: 222 WILLIMANTIC DRIVE �jX, ----MARSTONS MILLS, MA 02648—.Signatuc� LIC.NO.: (If applicable,ente (508)428.7747 'rm.) Address: Bus.TTel.No.• 17i 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: I am aware that the Licensee does not have the liability insurance coverage n— o - nally 5 required by law. By my signature below,I hereby waive this requirement. I am the(check one)[]owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $