BLDE-21-007099 Commonwealth of officia,
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Massachusetts Permit No. BLDE-21-007099 use only
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•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 pertorm the electrical work described below.
Location(Street&Number) 50 REFLECTION WAY
Owner or Tenant William Bryan 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: Wiring for A/C system in attic.
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 ❑ 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 ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE:$50.00
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, -=., BOARD OF FIRE PREVENTION REGULATIONS
Occupancy and Pee Checked ��_
cave blank�pR,pERMtT TOP PERFORM ELECTRICAL
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work to be performed in accordance with the MassachusettsC. 27 GMR IZ,00(PLEASEPRINT IN INK OR TYPE ALL INFORMATI
By this a City or Town of: BUT Date: 2
application the Imdmigned vas nod of h s or h intention o perform the To the e e or of work described
Location(Street&Number)
.� � P �A sal described below
Owner'or Tenant 1, kk. •
Owner's Address Telephone No.
Is this permit in conjunction with a binilding permit?Purpose of Building
Yes ty heck Appropriate Box)
Amps ! UtilityAutirotation No
Existing Service
New S rvlce -^-L...,, _..Amps ! Volts Volts Overhead Cl Undgrd
..�._ No,of Meters
Number of Feeders and Anspaci~�`�" Overhead Undgrd
Lotion and Nature of Proposed Eteatr g No,of Meters
a Work� r`
72...-___A- K C.— -----
o
No.ofCorn•letion o the allowtn_ table tn. be waived• the Ins,actor a
No,of Race naitro Outlets No.of Cell.-,Susp.(Paddle)Fags o.o Aires,
No.of Hot Tubs Tranafo .era K
Iteeesse• Luminaires VA• No,of Luminaires
S P►'lmming Pool rnd e 0 n' g Generators KVA
'0.0 'merges) la g
No.of Receptacle Outlets d' Batts Units u •
No.of Oil Burners
No.of Switches , ---- • ;; .
o.o No.of Zones
No.of Ranges HersMUM
ms an,
Na of Mr Cod Initiatin_ Devices
No.of Waste Disposers 'ea sup .d. •e o r �.
Tan No.of Alerting Devices
No.of Dishwashers Totals: '"" "T-`• Rns
on ne.
Detection/Aladin: Devices
No.of Dryers
Space/Area Heating KW' Local 'un ca pa
Heatin ❑Connection ❑Other
`o.o ►� g Appliances arer ► ecu :*
Heaters KW `o.o ys ms.
O.o No.of Devices or E.ulvalent
No.Flydromssssage Bathtubsi_ s Ballasts Data Wiring:
Na.N of Motors No.of Devlee or E.uivalent
OTHER: Total HP a ecommun cat ons "'r'ngg.
No.of Devices or '. ivalent
Estimated Valu lac •
Attach addition?!detail •
Work to Start: 1 Work: U'desfred or as required by the inspector of Wires,
SURANCE CO . I Inspections to be requested in accordanceywi h municipal Rule i 0
the licensee � la. Unless waived bywith MEC Rule l0�and upon completion,
provides proof of liability insurance including er,no permit for the performance
undersigned certifies that such coverage is ra ce p rmanoe of electrical work may equivalent.
CHECK ONE; INSUfRANCE "completed roo fofse ac to ee or its substantial
ssuing of ce. alent6 The unless
jv RANCE� BOND �end has exhibited proof oFsa
r � ,ONE !N -_R._ _ .,_ 0 OTHER S me to the permit issuing office.
FIRM NAME: '�-" .''_ ... poci on on lb
WAYNE SCHMIDT "y,that theln oralKers
Licensee: 222 WILLIM ELECTRICIAN
f on th cat!`n!s true and c nr
'—`—MAR 2 WIL ANTIC DRIVE plet4
(11applicable,ante MILLS MA 0264 in.,,_Stgnaht LIC.NO•: � CJ'(a'
Address: (508)428-3747 'ne.) -°- �� tt
r1 "Per M.O.L.c, 147,s.57-61,security LIC'NO,:
OWNER'S INSURANCE hr work requires Bus,Tel.No.: arm.
required M.by law. g NCE� sec rity I q res Department of Public Safe Alt.Tel.No.; 'tly_r_, ,'r'�'
Y my signature WAIVER:
ER: a ewmo that the Licensee does not have t,License* Ltc,No, t
t Owner/Agentquired by waive this requirement. I am the(ch(check one insurance:Overage
Slgnahsr ga no
owner rurally
.. Telephone No. ��- own a ant
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