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Home My WebLink AboutBLDE-22-000164 or Commonwealth of Official Use Only 4` Massachusetts Permit No. BLDE-22-000164 '�� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked — [Rev.1/071 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) 29 SKIPPER LN Owner or Tenant Roger Mello Telephone No. Owner's Address MA 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 furnace. 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 o 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. To No.of Alerting Devices 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 ❑ 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 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 Fe Y 0 CK3i Com monweakh o/Massaehusett Official Use Only 11.- .252.7--Cc �9 �` - c� c7 Permit No. el .. -(JSparllnent o/.}ire Serviced • •_ =T'_ ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] • (leave blank) APPLICATION *FOR..PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricalAde 05217 p2.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIO1� Date: City or Town of: YARMOUTH To the Inspector of Wires: By this application the tmdersi a d ves notic o his or h 'ntention to perform the electrical work described below. • • Location(Street&Number) � ;1�_ L , • IF -am Owner or Tenant V ' 'V Telephone No. . —1. I .9.., 1111111 Owner's Address ,'41 fV .j� Is this permit in conjunctionwith a bui)ding permit? Yes El No (Check Appropriate Box) Purpose of Building D w3\\ iUtility Authorization No. Existing Service Amps / Volts Overhead Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity e Lotion and Nature of Proposed Electrical Work: `' qui • 11111C-'1. A NIIS u l' 1u !tc r Completion of the following_table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Celt.-Susp.(Paddle)Fans No.of Total ,Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA - No.• of Luminaires Swimming Poot Above ❑ In- 0 No.cif-Emergency Lighting grad. ern. 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 InitiatingDevices _ No.of Ranges No.of Air Cond. Tons No.of Alerting Devices • No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:I----""�" I""— "' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local Municipal Connection ❑ Off• No.of Dryers Heating Appliances KW 'Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: - Signs Ballasts No.of Devices or Equivalent No.Hydi omassa-ge Bathtubs INo.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 Val l k: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O ERA E: 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 X BOND ❑ OTHER$ (Specify:) (Jo cKers C vp I cern ,under 1L---=--- --'- -"-- +�'�� ff WAYNE SCHMIDT y'��the information on this icati n is[rue and complete FIRM NAME:- ELECTRICIAN ll LIC.NO.: qCi 222 WILLIMANTIC DRIVE--MARSTONS MILLS, MA 02648—.Stgnatu (,L t` LIC.NO.: Licensee: (If applicable,ante (508)428.7747 ne.) Address: Bus.TTel.NNo.•M53. ,,, 71 j "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt Lic.•No.•� 2 ,- OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage noryall required by law. By my signature below,I hereby waive this requirement. I am the(check one 0 owner 0 owner's a_ent. S Owner/Agent Signature Telephone No. PERMIT FEE: $ `�