Loading...
HomeMy WebLinkAboutBLDE-21-007096 Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-21-007096 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:6/7/2021 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 eectncal work described below. Location(Street&Number) 28 PLEASANT ST Owner or Tenant THOMAS J ROCHE REALTY INC Telephone No. Owner's Address 28A PLEASANT 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 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: Wiring for three(3)split A/C's&install sub panel. 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 grnd.Above ❑ In-grnd. ElNo.of Emergency Ligh J Battery Units Q No.of Receptacle Outlets No.of Oil Burners FIRE ALA' ► i f O No.of Switches No.of Gas Burners No.of Detection Initiating Devices O No.of Ranges No.of Air Cond. 3 Tons Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained < S� Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ : ,N Connection No.of Dryers Heating Appliances KW Security Systems:* `40) 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: $50.00 FeeSO CKGr11 . . aminonu m&o/rriassee e s yd,- _i ee77 �r�...,,,- amino. ; ��a�app so Only (�/ T . epo „ant /.�''lre. err hes Permit No.I� ��C- © l �P ( : 1 r BOARD OF FIRE PREVE (R NTION REGULATIONS Occuan j and Pee Checked ey. 1/07] • . ilcave blank) APPLICATION 'FOR;PERMIT TO PERFORM ELECTRICAL WORK MI work to be pertbrmed in accordance with the Massachusetts Electrical C (PLEASE PRINT IN INK OR TYPE ALL INFOR1I4T1A Date: �I'� I12.00 = City or Town of: • o UT • By this application the de no To the Inspector of Wires: oigne gives no oe • or her Intention to Location(Street&N tuber) ,$ perfo •• the electrical work described below. Owner'orTenan ''s 1'i Auri �D$- Owner's Address �'A- • Telephone No. , Is this permit in conjunction wjb •h ugding permit? Yes ❑ No Purpose of Building (Check Appropriate Box) Utility Authorization No. Existing Service Amps _..�..,..Volts Overhead 0 Undgr-d.0 No,of Meters ew S ce Amps /I Void Overhead 0 Undgrd 0 Nd.of Meters Nuiaber of Feeders and Ampacity LoAtiort and Nature of Prop.sed Eleatrlcal Work: 2 M._._____Libis_bi, ... - qtr ;" , -n o the allowt ; table to. be waived. the Ito•actor o Wires, No.of Recessed Luminaires No.of Ceti,-Susp.(Paddle)Pans `o.o KVA No.of Lumtaalro Outlets No. •ars No.'of Hot Tubs Generators KVA • No.of Luminaires Swimming Pool ,rude ❑ n. , ' ' 'Units mergen *g -ug • No.of Receptacle Outlets = d• ❑ Bane No.of Oil Burners FIREALAItf5 No.of Zones No.of Switches �- . : e.o' t - :on an No.of Ranges ' ' Inidattn_ Devices Na of Air Conti. oo " No.of Waste Disposers Tons No.of Alerting Devices Totals: riga• o a r D n No.of Dishwashers Detection/Alertin: Devices Space/Area Heating KW' Local❑ 'un pa No.of Dryers Connection 0 Other Heating Appliances ecu yy . `o.o "trier KW No.of Devices: or E•ulvalent Heaters KW `o.o `o.0 Data Wiring: No.Hydromassage Bathtubs Si._No.of Motors Total HP a ecommun at ons " r ng: OTHER: No.of Devices or ' •uiviient • Attach addtltonft detail(bleared or required by the inspector of Wires. Estimated Valu El 'Cal Work: Work to (When required by municipal policy,) Work to Start:rCO lnspeetlons to be requested in accordance with MEC Rule 10,and upon completion. RAGE: 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 e undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE; INSURANCE equivalent. The T Herdt ,undeONE. IN ` RANCE X BOND 0 OTHER X(' $ ex g FIRM NAME: WAYNE SCHMIDT 7',that the inform• on on th call true and a rnpleta ELECTRICIAN Licensee: 222 WILLIMANTIC DRIVE ! h. LIC.NO.: � 6at Licensee: :—MARSTONS MILLS MA 02648...,_Siena"' v ; ' "- Address: (808)428.747 'ne.) LIC.NO.: J `Per M.O.L.c. 147,s.57-61,security Bus.Tel.No.- r. �'7, OWNER'S INSURANCE h'work requires Department of Public Safe "S"License: Alt.Tel.No.: _r g►10 lcr. �' Lie.No. RANCE WAIVER: I am aware that the Licensee does not have the liability required by law. By my signature below,I hereby waive this requirement. I am the(check oninsurance coverage normally Owne4gent Owae'dre ;—"" _ owner owner's a ant '�� Telephone No. PF,RMrT FRP. e