HomeMy WebLinkAboutBLDE-21-007560 Commonwealth of Official Use Only
� �. `I Massachusetts Permit No. BLDE-21-007560
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:6/29/2021
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) 81 NORTH DENNIS RD
Owner or Tenant Theresa Napior Telephone No.
Owner's Address 81 NORTH DENNIS RD, 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 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: Air conditioning system in attic. /
Completion o/the following table ay�f%�a�g 5 e .p for of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of
Transform Q
No.of Luminaire Outlets No.of Hot Tubs Generators
•
No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency L _do
grnd. grnd. Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Z� 0
:0
P V
No.of Switches No.of Gas Burners No.of Detection and
Initiating Devices v
No.of Ranges No.of Air Cond. 1 Total 2.5 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 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 Stens 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
rtt- .-37) CKGyi3) .
/r yy�
t C.on�nortwra e f///adeacrd
( . ' Ziparinwnt of giro Sewtare Permit No. G '� C.C+o
BOARD OF FIRE PREVENTION REGULATIONS ,0e'Occupancy and Poe Checked 1 ' `
APPLICATION �QRI PERMIT TO PERpO � cava bhutk
All work to be peribtmed in accordance with the Massaohasotu Ele ui ELECTRICAL 12.00 WO K
(PLEASE PRINT IN INK OR MR ALL INFOR4(i42 •
City or Town of; OUT Date:
By this application the d To the Inspector of Wires;
lm cgn d _ ves no ce of h •r her ten on to
Location(Street&Nu ber) °�the olectt3oai war described below.
Owneeor Tenant V - _ - Ii. ` �A A r 11'...a j� 3
Owner's Address Telephone No.
Is this permt in conjunctfon�with aTiding d .-
Purpose of ittildhxg Pemit? Yes 0 No ....
a
(Check Appropriate Box)
Existing S -- - sUtility Authorization No.
Volts Overhead t� '
I L.,t. Und rd
ew S rvtce Amps / g C] No.of Meters
Number of Feeders and Ampact
••••••••••••••••--___
� _Vohs Overhead Undgrd 0 rid.of Meters _
c ,,,,„
Lo�tiop and Nature of Proposed EleGtrtc Ia Work� •
...us...„,4
MX Aw L_ 71141,
N .of Recessed Luminaires Corti•letton , the ollowt : table nt• be waived, the Ins.actor o Wirer,
No.of Ceitsusp.(Paddle)Fens • `0,o
No.of Luminaire Outlets Ge Transit)v -ra KVA
•
No.rof Hot Tubs
No.of Luminaires Generators KVA
Swimming Pool ,rude L :Aid.a. ❑ Balte Units
a g ng •
No.of Receptacle Outlets
No.of Of!Burners '
No.of Switches No.of Zones
No.of Ranges Na of Air Conti LIZ Devices
No.or Waste Disposers .(0 T°ons No.of Alerting Devices
•
Dateoctiod.�le n Devices
No.of Dishwashers on ne
Space/Area Heating KW' .nn a
No.of Dryers HeatingLocal 0 Connection 0 Other
`o.o +�a er Appliances KVtr •taco Ys ccs
Heaters KW o.o ,o.o No.of Devices or B•ulvalent
o as Ballasts Data Wiring:
No.Hydromassage Bathtubs No.of Devices or E.ulvalent
No,of Motors Total HP a ecotnroan eat ons r ng:
OTHER: I
N. of Device: or ' ,uiva-lent
•
Estimated'ValuO ec 1 Work:
Attach ad- 'anal detail fJ'desl1 it:"�Mags �P/�
Work to Start: �q meq required by municipal policy.)
r trod by the Inspector/Wires,
Work to
CO K Inspections to be requested in accordance with MEC Rule 10,and upon completion.
RAGE: Unless waived by the owner,no permit for the performance of electricai work may issue unless
the licensee provides proof of liability insurance including"completed operation coverage or its substantial
undersigned certifies that such coverage is in force,and has exhibited
CHECK ONE: INSURANCE proof of saute to thendal equivalent, The
under t X BOND 0 OTHER permit Issuing ofi`ice,
r aerie. ,.___�.._ _.. ..,... .'_..... �(Specify:) � �(�.�
FIRM NAME: WAYNE SCHMIDT 9,that the!r{/brrn• .ort on th c n true and e m
ELECTRICIAN plata ��
Licensee: 222 WILLIMANTIC DRIVE LIC.NO
�---MARSTON8 MILLS MA 02648....,. g to�,�„�I A ��
Sl na �_ ' „
(Iappltcable,ewe (508)428•x'747 inc.)
LIC.NO.:
t
Address;
J '"Per M.O.L.c, 147,a.57-61 security Bus.Tel.No. . ,/ s' "7
h+work requires Department of Public Safety"S”License: Alt,Tel.No.; _.-1.[ar A' /t
�t OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance cove`'"--
required by law. By my signature below,I herebywaive this r
t• Owner/Agentrequirement. I am the(check one raga n°tmally
( owner
�`� Signature -'""'—'"` .,,, owner's a ant.
Telephone No. `7:--------
PR,RMI'T nwn. e