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HomeMy WebLinkAboutBlde-21-001444 ar Commonwealth of Official Use Only fi." ,1 Massachusetts Permit No. BLDE-21-001444 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:9/22/2020 City or Town of: YARMOUTH To the Inspector of Wires: ` 1 ,, By this application the undersigned gives notice or his or her intention to pertorm the electrical work described below. :T.' `' Location(Street&Number) 79 MID-TECH DR UNIT C �:�yf ' Owner or Tenant HAPPY DOG OF CAPE COD _ Telephone No. SFP �� ,;,• Owner's Address 79 MID-TECH DR UNIT C,WEST YARMOUTH, MA 02673 / Is this permit in conjunction with a building permit? Yes 0 No 0 (Check App opy�iatb f i . �2 2©IQ Y Purpose of Building Utility Authorization No. '' ''`: Existing Service Amps Volts Overhead 0 Undgrd 0 No 4` e •rs '- ' "' New Service Amps Volts Overhead 0 Undgrd 0 N I t4.? - .,__ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement HVAC. w 4/78Completion of the following table may ai e y ;.Insf Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of dri•• Transformers No.of Luminaire Outlets No.of Hot Tubs Generators 01Z3 4.W No.of Luminaires Swimming Pool Above ❑ Ind ElNo.of Emergency Lighting /� g l: Batter,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 Initiatinu 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/Alertinii 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 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$80.00 K) CRG-5. `V Con+awruuea al///adsachu�e ,�,Y.,:; Official Use Only 111 f�_-^ a [ s Permit No. L -14414 parimant o ervice$ ' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] ' .,,,,,• (leave blank) APPLICATION 'FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod C),527 C 12A0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I il City or Town of; YARMOUTH To the Inspector o Wires: . By this application the undersigned ' es notice of his or her intention to perfo the electrical work described below. fl' Location(Street&Number) a-ROA D-k C • s vg. Owner'or Tenant Telephone No. Owner's Address ' ..-- Is this permit in conjunction • h a 'u ding permit? Yes No ��' ❑ ,,. (Check Appropriate Box) Purpose of Building ``=� Bps,K Utility Authorization No, Existing Service Amps / Volts Overhead ❑, Und rd g ❑ No,of Meters New Service Amps / Volts Overhead ❑ Undgrd l; 0 No,of Meters Number of Feeders and Ampacity �----- a Nature of Propos d Eke ical Work: i L \„, l G- LoAtiop its �� a Completion of the following table may be waived by W the Inspector o ires.�� No.of Recessed Luminaires —No,of Cell.-Susp.(Paddle)Fans No.of Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above in- No.of Emergency Llghnng - _grad.. ❑ grad. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches , C.,) No.of Detection and t Initiating Devices No.of Ranges No.of Air Cond. TTons No,of Alerting Devices • No.of Waste Disposers Heat Pump r Rumber,•Tons'KW_. -No.of Self- ante ne Totals:i "" Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW' Mun cipal 'Local 0 Connection 0 Other No,of Dryers Heating Appliances KW Security Systems No.of Water No.of Devices or Equivalent Heaters KW No.of No.ofa� WtrIngt Signs Ballasts No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total•HP Teiecommunicat ors tr ng: No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of ectri al Work: (When required by municipal policy.) Work to Start: 6 ` Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO ERAGE: 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 X BOND 0 OTHER$ (Specify:) WO cKe s C I certi , under t'----'--- --a---•-"_.- ..... FIRM NAME; WAYNE SCHMIDT y+that the Information on this icatr n is true and complete -rc6q ELECTRICIAN � LIC.NO.: � Licensee; 222 WILLIMANTIC DRIVE Licenaf see: -applicable, n MARSTONS MILLS, MA 02648— Signaht LIC.NO.: (508)428.7747 'rte.) ----------_._ Address: Bus.Tel.No.• �'7, j "Per M.G.L.c, 147,s.57-61,security work requires Department of Public Safety S License: Alt.Lie.No. / — OWNER'S INSURANCE WAIVER: I 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 CD owner's a ent. Owner/Agent ,,I Signature Telephone No. , PERMIT FEE: S1