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Home My WebLink AboutBLDE-23-000135 Commonwealth of Official Use Only 1(40p Massachusetts Permit No. BLDE-23-000135 €� 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:7/11/2022 City or Town of: YARMOVTH To the Inspector of Wires: By this application the undersigned gives notice of liis or her intention'to perform the electrical work described below. Location(Street&Number) 5 AMOS RD Owner or Tenant Sarah Dever '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 ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace old devices,check wiring&receptacle for range. 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 Arnd. 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 1 No.of Air Cond. Ton l 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 ❑ (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 -f&ZS 00'15-8, • • ' C°,>monwaa oi,�/aeeac�Zudej Official Use Only }'t1 l '" .�eparttnent o .gtr Serviced Permit No. (_- y a �_(, ,�,, BOARD OF FIRE PREVENTION REGULATIONS [ReOccupancy c 1 p cy and Fee Checked APPLICATION.:FOR PERMIT TO PEtFOELECTRICAL leave blank All work to be performed in accordance with the assachusetts Electrical s ELECTRIC �� (PLEASEPRNTINIIIIKO L27 112.00 Date: City or Town of: By this application the undersign ves o ce of his or her ention to performthTo the e lectrr cal of work Location(Street&Number) described below, or C� Tenan Owner's Address Telephone No.gg Is this permit in conjunction wit Purpose of Building �a building g permits. Yes ❑ No (Check A ° Existing Service Utility thuriziation No,Appropriate Box) Amps •_Volts Overhead _____ ow Service �^ Amps / ❑ Undgrd❑ No.of Meters Number of Feeders and Ampact -'Voits Overhead El Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: VAIIIMMITIM u...,_• AMA CAPrt No,of Recessed Luminaires Com lesion o the ollowin table i a be waived h the Ins ector of Wires, No.of Cell.-Susp.(Paddle)Fans o.o KVA No,of Luminaire Outlets Transformers No.of Hot Tubs • 10.of Luminaires Generators KVA Swimming Pool rnd @ ❑ n- o.o mergency g i ng No.of Receptacle Outlets rnd. ❑ Batter Units No.of Oil Burners FIRE ALARMS No,of Zones No,of'Switches No.of Gas Burners o.o e ec on an No.of Ranges uta Initiatin Devices No.of Air Cond. No.of Alerting Devices No.of Waste Disposers Tons posers 'eat 'ump ` OW..�»....N„ „. `o.o e - on a ne, Totals: ........• No. a of Dishwashers � � Detection/Alertin� Devices • Space/Area floating KW' Town ei No.of Dryers HeatingAppliances Local 0 Connectionp ❑ Other -`o.o "a er PA K�, ecurity stems:* . Heaters KW `o�o No.of Devices or E,uivalent Sins Ballasts Data Wiring: No.Hydromassage Bathtubs o. e ecomNo.of Devices or E,uivalent • Imnemow. o.of Motors Total HPmun cations "ir ng: 1 OTHER: 1�a%� ,e(A) 1 / No,of Devices or E uivalent Estimated Value f 1 cal Work; Attach additional detail fides ed,or as required by the Inspector of' as. Work to Start: , 2-1-• (When required by municipal policy.) SURANCE 0 Inspections to be requested in accordance with MEC Rule I0,and upon completion. INRAGE: 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 undersigned certifies that such co rage is in force,and has exhibited proof of same to the permit issuing CHECK ONE: 1NSURANCt 1 equivalent, The I eerti BOND 0 OTHER ( p �,:) office, FIRM NAI WAYNE SCHMIDT" " "'tat the information on this application is true and complete. ELECTRICIAN Licensee:- 222 WILLIMANTIC DRIVE LIC.NO,; C CI (f1'appiicabl� MARSTONS MILLS, MA 02648 Signature �_r �. • Address: (li08)428.7747 LIC.NO,; Per M.O.L.c, 147,s.57-6I,security work requires Department of Public Safe Bus.Tel.No: *fa OWNER'S INSURANCE WAIVER: Tam aware that the Licensee does not have theAlt.Tel.No . I;1AI 21'7i ed bylaw. Byh' S License: Lie.No, Owner/Aent mY signature below,I hereby waive this requirement. I am the(check liability insurance coverage normally Signature ❑owner 0 owner's a:ent, Telephone No. PERMIT FEE. $