HomeMy WebLinkAboutBLDE-22-000175 a Commonwealth of Official Use Only
fel I ti- Massachusetts Permit No. BLDE-22-000175
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:7/12/2021
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.
Location(Street&Number) 76 STRAWBERRY LN
Owner or Tenant CORDERO HUMBERTO Telephone No.
Owner's Address ''ltLF1" 16 STRAWBERRY LN,YARMOUTH PORT, MA 02675-1725
Is this permit in con ` '---i'in^i ng permit? Yes 0 No 0 (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd 0 4 • ers
New Service Amps Volts Overhead 0 Undgrd 04..., . ow
Number of Feeders and Ampacity ..4?
jy/
Location and Nature of Proposed Electrical Work: Miscl.work per attached.
4pCiCompletion of the following table m •/ 4, e > eo f Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans
No.of o
Transformers
No.of Luminaire Outlets No.of Hot Tubs Generators 6,
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 No.of Detection and
Initiative 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/Alertine 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 Ballasts Data Wiring:
Heaters Siens No.of Devices or Eauivalent ,
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 ofperjury,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
N"774 7/ Y(u (e Cro : ifiAii,)
Fet.4 CKG3q . •
. .
�o, , . ry�
at o •
f ii/adeaC a v..,: o a loo Only
{ Zsparfi,wnt of Services
Permit No. -Q ��
BOARD OF FIRE PREV N Occupancy and Poe Checked
• ,� TION REGULATIONS . I/o71
cave blank
APPLICATION F'QR;• 'PERMIT TO PERP c
All work to be peribrmed In accordance with the Massachusetts Electrical RM ELECTRICAL CA.0 WOR K
(MASA'PRINT 1N INK OR 7178 ALL INFOR4IA s27 CMR 12.00
City or Town of: __ ` �(�jJZTCl Date::
• By this application the wide* d es n.,o of h s or her sten on to perform to Inspector of kdoiWires:
. Location(Street& umber) cal wo k do bed below.
1 (082-
NI
Owner or Tenant
Telephone No,
Owner's Address ' '. '���
Is this permit In conjunction with a u � �,
king permit? Yes 0 No IN {Check Appropriate Box)
Purpose of Building
- - us0�Service Amps /
Utility Au+►arm bion No.
ew S Ce ....._Volts Overhead ElUndgrd�•��tt
Amps •
�•J No,of Meters _
Number of Feeders and Ampaat `Voi Overhead❑ Undgrd❑ No,of Meters
Lovtiop and Naturesf Proposed Electrl IAC W rk_ 1S Lks
No.of Recessed LuminairesCora•legion o the (Nowt : table nr• be waived. the les.ector o Wires.
No,of Luminaire Outlets No.of Cell.-Soap.{Paddle)Fans VA
o.o
Transfo . -ra K
No.of Luminaires
No.of Hot Tubs
Generators KVA
Swimming Pool rnd e ❑ n. .
No.of Receptacle Outlets d• ❑ Bette Urufb a g ng •
• No.of Oi!8urnors '
-170707F1itehee rip=r3, of Zones
No.of Ranges `o.Ia4Hat3n °�an
No.of Mr Cond. °" Devic
No.of Waste Disposers .,s trmp � Tonsi� `r No.of Alerting Devices
No.of Dishwashers T• $�• ' �■s '� on ne
Space/Area Heating KW Local ��n n Devlaes
No,of Dryers Local❑ pa
HeatingAppliancesConnection ❑ �•
o.o "star KW ecu s ems: '
Heaters KW e•o .o.o No.of ►eviees or E.utvalent
Si us Ballasts ate Wiring:
No.Hydromassage Bathtubs
No.of Motors No.of Devices or E•ulvalent
OTHER; Total HP a ecornman cat ons `' r n
No.of Devices or • .trivalent
Estimated ValToalWormaodds1sde,c,lya ,,e4Qrujredb ,h , .Work to Start (Wheq required by municipal policy,) ++spearor of Wires,
Work to Nt~g p Inspections to be requested in accordance with
RAGE: Unless waived by the owner,no permit for the performance SC Rule 1 el0,and upon completion,
the licensee provides proof of liability insurance including"completed operation"coverage
undersigned certifies that such coverage is in force p nnanae of electrical work may issue unless
ONE: INSURANCE ,and has exhibited proof of same to the or its sg office.equivalent, The
I CHECK BOND ❑ 0• ER$(Specify') Wpermit Issuing
cede,under t .,_.... �
to... -T....• � C
FIRM NAME: wA igTBCHMIDT y,that the lnjorm• on on as •
ELECTRICIAN rl trite and c nrplete, ?6(�'
Limns
- 222 WILLIMANTIC DRIVE a LIC.NO; -•a. J tr
�UaPPleel--,—ente—MARSTONB MILLS MA 02648...,.,Signatu�� rte; ,/....it "....,------...�.
Address; (508)428. 747 Ana) LIC.NO.:
-1 `per M.O,L.,c, i4?,S.57-61 s Bus.Tel.No.. r`'"""
INSURANCE WAIVER:"'�work requires Dept of Public:Saye ��g�� Alt.Tel.No.: _:Ifs`' �"' 2/7
OWNER'Sed by law.INBy I am aware that the Licensee does not have License: ran,No. t
Owner/Agent „,_ signature below,Y hereby waive this raquiremant, I am the{chock one
the liability insurance eoveragrage n t.
Si afore �"' ' owner
,�t Telephone No. - owner's ant,
PRRM'rT Rett. e
1 co 1
a 3 �of —z13L
,gs 3\tid
e ( -430,16
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