Loading...
HomeMy WebLinkAboutBLDE-22-003152 e Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-003152 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:12/2/2021 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. , be Location(Street&Number) 15 SILVER LEAF LN / Q/ 7j�2-6 o 5 Owner or Tenant Robert Munsey Telephone No. Owner's Address 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 boiler 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 Initiatine Devices No.of Ranges No.of Air Cond. Total 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 ❑ 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 Ballasts Data Wiring: Heaters Signs 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 my 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 (4/14 7J7/7v 7/2. 1y1/et{(©`. n444 Liv) 1/2-/Z52 f . F-ce 50--- G kcrafRy • \ ComnwruveaUh of Madsac etfs - Official Use Only 1----77-:_. / � Permit No. .I- �eParneno`cire Serviced :=4.11___'-= :* Occupancy and Fee Checked • Y = <:' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07) (leave blank) r APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code )42 CI�R 2.00 (PLEASE PRINT IN INK OR P ALL INFOR ION) Date: �� City or Town of: �w10(� To the Inspector of Wires: By this application the undersign_fives Vice •f his or he intentio. to perform the electrical work described below. Location(Street& ► . • b: ) v ' r 't L jl g' Owner'orTenant • .0 ' C. Telephone No. itiM_trih Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No Pq (Check Appropriate Box) Purpose of Building C)w_e-1,`.\A Utility Authorization No. Existing Service Amps - / Volts Overhead D. Undgrd 0 No.o€1Mdcters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity L cation and Nature of Proposed Electrical Work: CO I rG e p LC�.0 o ytele 6,1g- • f-• Completion of the followink table 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 Swimming Pool Above 0 In-' ❑ No.of Emergency Lighting • grad. grnd. Battery Units No.of Receptacle Outlets Nif DiLBurn rs .ThFIRE ALARMS No.of Zones • No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.o rr on . Tons No.of Alerting Devices No.of Waste DisposersHeat Pump Number ons KW_ No.of Self-Contained Totals: • Detection/Alerting Devices . . No.of Dishwashers Space/Area Heating KW' Local❑Monunnicipalection 0 Other C No.of D ers Heating AppliancesSecurity Systems:* rY KW No,of Devices or Equivalent Fio-.Of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent • ommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP Tel No. of Devices or Equivalent I OTHER: • Attach additional detail if desired,or required by the Inspector of Wires. Estimated Value of ec 'c 1 Work: (When required by municipal policy:) Work to Start: ., 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RA +: Unless waived by the owner,no perniit for the performance of electrical work may issue unless the licensee proyides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The • undersigned certifies that such cov rage is in force,and has'xhibited proof Of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER ❑ (Specify:) • I certify,under the pains and na esof perjury,that the inform tion.on this , pr•ation true and completes �3 • FIRM NAME: WAYNE SCHMIDT y f LIC.NO.: � i ELECTRICIAN ���///���111 Licensee: 222 WILLIMANTIC DRIVE Signare / tuLIC.NO.: (if applicable.ente.MARSTONS MILLS, MA 02648 , Bus.Tel.No.: OQ 737.071 • Address: (508)428-7747 Alt.Tel.No.: OO . *Per M.G.L.c. 147,s.57-61,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)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ ,�