Loading...
HomeMy WebLinkAboutBLDE-21-007102 Commonwealth of Official Use Only .4?I ft. Permit No. BLDE-21-007102 , vu Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.I/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 electrical work described beloyl ^ Location(Street&Number) 28 BRAY FARM RD NORTH (�� p,V � f-i Owner or Tenant A,PleterrIVZIMAr Telephone No. Owner's Address 28 BRAY FARM RD NORTH, YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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 split A/C system. 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. 1 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 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 Signs 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 o f 9(-) (2-t C(7 os PM Liti►) 6..()sA do kiLis- 76, ©i 17 yfr ct/ 2i CI 1:A 1 1) Sbs -ew.- 32)4 eta fro is 124 es . 08- .36 Fee ..:5 cdi<G---3Lt,,,7, _ • it ,'. C.or+urwnuiraGth f adJaC r�J .•. fFais)Use Only y"'-"^-- �_,�,. ,. �Tr ' rPa+fmanE oilrr ServicedPermit No. ���'� %,'-'7,:' a BOARD OF FIRE PREVENTION REGULATIONS Occupancy 'd Fee Checked v. 1107J save blank APPLICATION 'FOR�'PERMIT TO PERFORM ELECTRICAL WORK MI work to be performed in acconjance with the Massachusetts ElectricallC (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) (MEC),527 CMIt 12.po City or Town of: 1 Date. 3 By this application c yor the ed fives notice of(1 or intention toperformT $� To the Inspector of Wires: Location(Street&Number) /� ��� the electrical work described below. Owner'or Tenant l �1�� �'� Owner's Address Telephone No._�5 (�7 7 .- Is this permit in conlunctlon with a bu din � Purpose of 8ullding ('. �f �� g permit? Yes No (Check Appropriate Box) � Existing Service lrrtjli�,f Authorization No, --^- Amps I Volts Overhead ❑. Clndgrd0 No,of Meters _ _New Service-- Amps ' Volts Overhead 0Undgrd 0 No,of Meters Number of Feeders and Ampacity _ Loifon and Nature of Proposed Electrical ,ork,1 c --^------ ___(,...iki ( t 1 ,frt...., .. T. "'"--"--C1°-\j"-l- '"-l""f-'-1-4";--- ' ' Com•lettan o the allow.in: table rrr- be waived li the Ins,actor o Wires, No.of Recessed Luminaires No,of Ceii,-Susp,(Paddle)Fans .`o.o No,of Luminaire Outlets Transformers KVA No.Hof Hot Tubs Generators KVA • No,of Luminaires Svc-inswing pool :rnd a ❑ Quid. ❑ Battery mergency x g ng No.of Receptacle OutletsUnits No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches � --"""`--� - "•"' ��is� 'a.of I etec an an• No.of Ranges Yn3tlatin_ Devices No.of Air Cond, °� No.of Waste Disposers Tons _ No.of Alerting Devices a eat 'ump `umber .ons rc, Totals: ."" ..,•_.---�- —...-- o.or e r on a ne. No.of Dishwashers Space/Art;a Heating KW Detection/Alertin•alDevices No.of Dryers Local Connection ❑ � j.s Heating Appliances ecuri`o.of ater KW county ystems;* Heaters KW °�° o, of No.of Devices or Ed uivalent Sl'ns Ballasts Data•Wiring: No, iiydromassage Bathtubs No,of Devices or E,uivalent No.of Motors Total HP Te ecommunic'ations W ring: OTHER; No,of Devices or E.uivalent Estimated Valu .o eecal W Attach additional derail if desired or as required by the Inspector of Wires, ork: Work to Start: (When required by municipal policy,) iNS17RAN inspections to be requested in accordance with MEC Rule 10,and upon completion, CE CO ERAGE: Unless waived by the owner,no permit for the performance the licensee provides proof of liability insurance including"completed operation"coverage or its substantial work may issue unless undersigned certifies that such coverage is in force,and has exhibited proof of same to the CHECK ONE: INSURANCEg substantial equivalent, The I r under - X BOND 0 OTHERr i� permit�is+suiyn�gyo�ffice. _.�,.... . (Specify:) is kK is 1.., f FIRM NAME; WAYNE SCHMIDT �'�that the Inform on on this Icati n is true and complete, ELECTRICIAN Licensee: 222 WILONS MILLS, DRIVE '" LIC.NO,: � 17��(If applicable, MARSTONS MA 02648, Signatu .�,_-36: , Address; (50$)428- 747 rite.) LYC,NO,; .l Per M.O.L.c, 147,s.57-6i,security Bus,Tel.No•: "'^`"`.T"- SOWNER'S CNSURAIVCE vyAY'VERW rra requires Department of Public Safe Alt•Tet.No.;` �I ' required by law, m aware that the Licensee floes not have the l ability insu acense: ince coverage `' Owner/Agent By my signature below, I hereby waive this requirement, Cam the(check one (� Signaturenormally �� Telephone No. owner ❑owner's a ent PF,Rttfir PPP. e