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HomeMy WebLinkAboutBLDE-23-001765 Commonwealth of official Use Only � `-4\ Massachusetts Permit No. BLDE-23-001765 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:10/4/2022 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) 9 AVON RD Owner or Tenant PAISLEY ROY N Telephone No. Owner's Address PAISLEY SUSAN E, 14 WEST BARD AVENUE, RED HOOK, NY 12571-1110 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: Split system(3 Heads) 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- ElNo.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. 3 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 c 0117 (tip l� c i0 ( etr>l 15653al AP---ro 6469a PPE Pt i,) . . fet:a. 60.....az. i • ,..„ '� --------. ommonwaa�l o f x a6eacketts Official Use Only •- apartment o �-*('llp� ( ;y f gire Services Permit No. (ate BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Pee Checked _ APPLICATION.FOR PERMIT TO p ([Rev, I/o7� leave blank � All work to be performed in accordance with the assach R4 FORM ELECTRICAL WORK Co(PLEASE PRINT INIh1IC O' City or Town of: ` i Date: 2.00 By this application the undersign c ves notice of his or r tention to performt To inspector o Wires: Location(Street& ' mber) I w electrical work described bolo Owner'or Tenant 0 i —'tl Owner's Address - Ea— Telephone No. ' - Is this permit in conjunction with a aildin • ' Purpose of Building g permit? Yes [� No ►1 �. .�/7' (Check Appropriate Box) t. Existing Service Amps UtilityAuthorization N Ne S rule '_---= Volts Overhead[] Undgrd II----•tt Amps / t_t No,of Meters Number of Feeders and AmpacityYolts Overhead 0 Undgrd No,of Meters .......;..('-) Lo ation and Nature of Proposed Electrical Wor No.of Recessed Luminaires k` , r Illowin: table ma be waived h the Ins,ector o Wires; No.of Ceil.-Soap. addle)Fans • cz: t No.of Hot Tubs -`o.o No,of Luminaire Outlets Transformers Iota VA • No.of Luminaires Generators KVA Swimming Pool ;rule ❑ r `ate Units cy g 1 rug No.of Receptacle Outlets ;Ind: 0 $aft. Units No.of Oil Burners No.of'Switches FIRE ALARMS No.of Zones No.of Gas Burners moo.o e ec on and No.of Ranges Inftiatin Devices No.of Air Cond. ota No.of Waste Disposers 'ea umpkial Tons +n•No.of Alerting Devices • No.of Dishwashers • Totals: ^•,R• o•o; e outs ne i Detection/Alertin Devices Space/Area Heating KW No.of Dryers Local❑•Cannectton ❑ Other Heating Appliances `o.o "star ICW ecu No.of ev ms: Heaters KW 'o•o `o.o of Devices or E.uivalent No.Hydromassage Bathtubs S` hs Ballasts Datallo.offing: No.of Motors _ No. Devices or B B.uivalent • OTHER; Total HP a ecommun`cat ons -"ring: No.of Devices or E t aivalent • Estimated Value o Eloc foal Worki Attach additional detail"desired,uired by ici or as required by the Inspector of Wires Work to Start: ' 22 Inspections to be requested in a(When ccordance with MEC Rule 10, �� INSURANCE C �' the licensee provides GE: Unless waived by the owner,no permit for the performance of electrical work may proof of liability insurance including"completed operation"cover Rule s and upon l equivalent, 3 undersigned certifies that such coverage is in force,and has exhibited proof of same to issue unless CHBCK ONE: TIVSURANCage or its substantial equivalent, The me, BOND [� OTHER the permit issuing office, I ear , '� -•-•�.-._. .. .l _. 0 (Specify:) FIRM NA! WAYNE SCHMIDT .'fiat the information on this application Licensee: 222 WILLIMANTIC DRIVE is true and complete. Licensee: - MARSTONS MILLS MA 02648 Signature LIC.NO.: • Address: (808)428.7747 LIC.NO.; "'Per M.G.L.c. 147,s.57-6I,security work requires Department of Public Bus.Tel.No.- ....' OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not haveyr. #' requiredbhc Safe '� �► Alt.Tel.No.:. '�3•+1�J • 4�1�� OWNS ' law. Bymysignature to S the liabilityLicense: Lie.No. r Owner/Agentla gnature below,I hereby waive this requirement. I am the(check insurance coverage normally Signatur q Telephone No. ❑owner []owner's et:.eat, PERMIT PM$ SO