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Home My WebLink AboutBLDE-21-005694 op Commonwealth of Massachusetts Official Use Only ,icitil Permit No. BLDE-21-005694 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:4/2/2021 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) 42 ALEXANDER DR Owner or Tenant RESIDENT Telephone No. Owner's Address BOGHDAN KALIL S,42 ALEXANDER DR,YARMOUTH PORT, MA 02675 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 Ni , au New Service Amps Volts Overhead ❑ Undgrd ❑ .of Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring for A/C system (In attic)and split a/c system. a Completion o the followingtable maybe wai404,21)I to>^b Wires. P r f No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of ►, Transformers ; No.of Luminaire Outlets No.of Hot Tubs Generators K 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 Initiatine Devices No.of Ranges No.of Air Cond. 2 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 Siens 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 e,. c,kG-42iy-tK • . amino. yy� ,t nurea of'///adsaca( y,r..•. ieleJ Use OOI }�, _ _.' .1JaParfrnant oi .o Jarvk�s Permit No. L. �S� ,, BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Pee Checked �y l (Rev. 1/07j anus blank --------" APPLICATION 'FOR.PERMIT TO PERFORM ELECTRICAL MI work to be performed in accordance with the Massachusetts Electrical CodeCAL WORK (PLEASE PRINT IN INK OR TYPE ALL INFO 527 c z,00 City or Town of: 0uT � Date:. • • By this application the d To the Inspector of fres: uncle:* aid vas node of his or her in don to perfo the electrical work desc 'b bel . • Location(Street&N tuber) Owner'or Tenant L U`�- — a�r�r` Owner's Address Telephone No. - r is this permit In conjunction with a bu din Purpose of>sui#ding ` g permit? Yes ❑ No (Check Appropriate Box) --� ___,_,_Utility Authorization No. Existing Service Amps --,.. ,.. ._,_,Volts Overhead�-•� New Service LJ. Undgrd❑ No.of Meters ------ Amps ram/ Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Lo don and Natur of Proposed Ele�ctricat "'� Fork: ` e Lsh i `) l c �5 No.of Recessed Luminaires Corn Istton o the ollowin table an be waived the Ins actor o Wires. No.of Ceti,-Susp.(Paddle)Pans o,o No.of Laminaire Outsets Transformers KVA No.sof Hot Tubs Generators KVA • • No,of Luminaires Swimming Paol ,rnd.e ❑ n. . mergency g ng No.of Receptacle Outlets d- ❑ $alto Units Batt:of Oil Burners Na, FIRE ALARMS No.of Zones � No.of Switches � -_ No.of Ranges Al!!!‘NI eta Yaitiat3n_ Devices o.of Air Conti. moo,of Alerting Devices No.of Waste Disposers ens • ea •ump um=er ons Totals: ...__._... `.` . e o e - on ne, No.of Dishwashers —' Detection/Alertin: Devices Space/Area Heating KW' Local❑ un cps No.of Dryers Heating Appliances eon Connection 0 Other o.a stet KW Ysteras, Heaters KW o=o No.of Devices or E uivalent Si ns Ballasts Data Wiring: No.Hydromassage Bathtubs No.of Devices or E uivalent No,of Motors Total HP a ecommun ca ons r ng: OTHER; No,of Devices or uivalent Estimated Value of Electrical W Attach additional detail{/'desired or as required by the Inspector of Wires. Work to Start: L (When required by municipal policy.) Work to Pardons to be requested in accordance with MEC Rule 10,and upon completion, INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work mayissue the licensee provides proof of liability insurance including"completed operation"coverage or its substantial undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuingo unless CHECK equivalent, The COWP I f under ItNSURANCE__ .A _ BOND OTHER$ (Sp�fy=) office. ONE: 1NSURA,NCE�.�.- .tT 0 O ("K�� FIRM NAME; WAYNE SCHMIDT 9,that the lnfortn on on this cam'n is true andlet ELECTRICIAN Licensee: 222 ONSWIL MILLS DRIVE ti:: (Ifappltcable.enteMARST(50 MILLS MA 02648.....(508)42s. 747 NO.: • rl "Per M.O.L.c, 147,s.57-6J s Bus,Tel.No.: r,. �' .� OWNER'S INSURANCE WA �ty work requires Department of Public Safe «S" Alt,Tel.No.: :Q1 �� NER: I am aware that the Licensee does not have the liabilityLin.No. I. Ow fired by law. . Bym y s�ture below,I hereby waive this requirement. I am the(chock oe insurance0a covora a now"""an g rurally Signature ❑owner owner's a ant '`� Telephone No. PERMIT PPP. e