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Home My WebLink AboutBLDE-23-003498 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-003498 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:12/27/2022 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) 36 BELLE OF THE WEST RD Owner or Tenant HOWLAND ROBERT A JR Telephone No. Owner's Address 54739 WILLIS ST, SOUTH BEND, IN 46637 Is this permit in conjunction with a building permit? Yes ❑ 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: Wire ductless AC,AC condenser, misc electrical. 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. Total No.of Alerting Devices Tons _ Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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: 12/21/2022 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 ❑ 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 fk5f) 0(4..4 3C 1 -7-- L -== Commonwealth e t�j� ', =f=l_ gi ///ir�dac�ttt�atts • Official Use Only at! •�UePartmartiF o� lre Serviced No. z3--3 `l.✓ BOARD OF FIRE PREVENTION REGULATIONS [ROccupancy y' 1/07J and Pee Chocked ` APPLICATION.:FOR PERMIT TO P FORM leave blank) All work to be performed in accordance with the assachus tt ® ca, �'��+T�r�+ �,.. WORK (PLEASE PRINT IN INK 0 L ),527 tO0 City or Town of: • Date: `�. i To the Inspector of Wires; By this application the undersign es n ice of his or he • Location(Street&Number) ) tion to perform Cthe ctrical work described below, Owner'or Tenant L.J 0 . Telephone No. '' Owner's Address f Is this permit in conjun tion with a b rildin this permit tea. q:� o t g permit? Yes n Ne El, . ""'•""'g u (Check Appropriate Box)• • �� --- Utility Authorization No, Existing Service Amps • / Newer 5Service Amps "Volts Overhead 0 Undgrd Meters -. NU.Uf NuMber of Feeders and Ampacity --"'Volts Overhead An. vir 0Undgrd ❑ No.of Meters Loon and Nature of Proposed Electrical Work: Com etion o the ollowin table ma be waived by the Ins ecc or of Ipires o.No.of Recessed Luminaires No,of Ceil,-Susp,(Paddle)Pans • No,of LutninaJre Outlets ra o kVA No.of Hot Tubs Transformers • No,of Luminaires Generators ICVA • S�virnnring Pool hove ❑ n- ❑ o.o mergency r t m No.of Receptacle Outlets -Ind. 1rnd'. Batter Units g g No.of Oil Burners ,VIRE - No,of'Switehes ALARMS No,of Zones No.of Gas Burners o, o electron and No.of Ranges of Air Cond. Initiatin. Devices eta No,of Waste Dis Tons No. of Alerting Devices posers eat ump umber - s " Totals on a.o e - ontaine No,of Dishwashers iDelection/Atertin Devices Space/Area Heating KW' Local urr c pa -----er No,of Dryers HeatingAppliances Canrrectron ❑ Other o.o ater pp YC W ecurrty ystems: --- Heaters 4vr ..".of No.of Devices or €+.errsiv,q„„+ rv�.ui Data Wiring: ` No.Bydromassage Bathtubs Si ns Ballasts No.of Devices or E trivalent • No.of Motors Total 1 IP eleco of Deviations irin : OTHER: U'AN No.of Devices or Equival er Estimated Value o ec ical Worki Attach additional detail tf desired or as required by the Inspector of Wires. Work to Start; '�� (When required by municipal policy,) SURANC:COVE Inspections to be requested in accordance with MEC Rule 10,and upon completion. IN �': 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, undersigned certifies that such co erage is in force,and bas exhibited proof of same to thepermit CHECIC ONE: INSURANCEq alr nt, The I certify, at " �'.- --... .. Y BOND (� OTHERissuing office, ..,.••...... 0 (Specify:) 1+IRM NAl WAYNE SCHMIDT 'at the information on this application is true and coanplete,ELECTRICIAN — Ai Licensee: 222 WILLIMANTIC DRIVE I:IC,N®, ,_� y2 �w ( (Ifapplicabl� MARSTONS MILLS, MA 02648 Signature • Address; (So8)428-7747 LTC.NO,: " Bus.Tel.No,: "�-�----._..."" '"Per M.G,L,c, 147,s,S7-6I,security work requires Department of Public Safety"S"License; Lic,No, �� Alt.Tel.No.;== OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage required by law, By my signature below,I hereby waive this requirement, I am the(check one . Owner/Agent b normally Signature El owner [J owner's a ent, Telephone No. PERMIT FEE $ `1)