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Home My WebLink AboutBLDE-21-003613 Commonwealth of Official Use Only Eor Massachusetts Permit No. BLDE-21-003613 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:12/31/2020 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) 25 SUNSET DR Owner or Tenant COOPER MELANIE H Telephone No. Owner's Address 84 OLD FARM RD,STURBRIDGE, MA 01566 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 ❑ Undgrd 0 of Meters New Service Amps Volts Overhead 0 Undgrd 0 ' sNumber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. R ZZ Completion of the following t&40 i e ' e I e t r of Wires. No.of Recessed Luminaires No.of Ceil:Sus addle Fans No.of Q 4 p ) Transformers No.of Luminaire Outlets e s No.of Hot Tubs Generators Em No.of Luminaires Swimming Pool Above CIIn- ElNo.of Emergency Ligl{ting- 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 aty�d ` c Initiative Devices/ U`C No.of Ranges No.of Air Cond. TotTons No.of Alerting Devi es _ 3.l�Q? . No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 'U Totals: Detection/Alertine Devie s No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 - , Othet: a 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: $50.00 11 3( FSO GkG- a- __,..e.„ ,_ l,ommonwea[h o/massacJ.4,ef.! Official Use Only It_-' !i c/� Permit No. C ^3 �P/5 c=_e!-c a L.lepartrnento`3ire)ervice! J' •� Occupancy and Fee Checked (�i BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leave blank) 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 P ALL INFOR ION) Date: 1 2 L I '?-) City or Town of: �U(� To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. L Location(Street&N _S ber) a $C� S e1 L N ST`� • Owner or Tenant ,' 0 V1 C O O P Telephone No. LI 3" C35'y Owner's Address Is this permit in conjunction with a building permit? Yes ElNoo (Check Appropriate Box) i Purpose of Building D W-_\,\ \A.5 Utility Authorization No. Existing Service - Amps / Volts Owl—head 1Jnd-grd 0 "o.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity cation and Nature of Proposed Electrical Work: C,J `r (RepL1,, m_e vdi G-i LLef 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 KVal KV Transformers A 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 CtiLBnrners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners I No.of Detection and Initiating Devices No.of Ranges No.o it on . Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers • Spae/Area Heating KW Local❑ Municipal ❑ fie, Connection No.of Dryers Heating Appliances KW Sestems:* curity Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent - No.Hy assage Bathtubs _ No.of Motors Total HP Telecommunications Wiring: qi o.of vices or Equivalent_ OTH ( ( - 1 li Attach additional detail if desirecj r as requir by the Insp tor of Wires. Estimated Value of lectr ccal Work: (When required by municipal policy) Work to Start: 11 Ia l )2e) 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 rage is in force,and has exhibited proof Of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) - • I certify,under the Pains and na • s of perjury,that the inform Lion,on this ' pt ation true and complete. Q FIRM NAME: WAYNE SCHMIDT LIC.NO.: ELECTRICIAN 01 Licensee: 222 WILLIMANTIC DRIVE Signature / LIC.NO.: (If applicable.ente.MARSTONS MILLS, MA 02648 , I Bus.Tel.No.:_?"— Q �j Address: (508)428 7747 Alt.Tel.No.:J 0 O 737�"'7I *Per M.G.L.c. 147,s.57-6I,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 0 owner's agent. Owner/Agent Signature — Telephone No. PERMIT FEE: $ 1 1