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Home My WebLink AboutBLDE-23-004498 Commonwealth of Official Use Only i�; kI Massachusetts"SrPermit No. BLDE-23-004498 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:2/14/2023 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) 17 POINSETTIA DR Owner or Tenant CIGANIK GEORGIA C Telephone No. Owner's Address BONGIOVANNI S& ROZEWSKI D, 101 SUMMIT ST, NEWINGTON, CT 06111 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: Replacement furnace. 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 1 No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Euuivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Euuivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 F,,,,_,:s-O , cx(c)--- -2,cpi: • .. ....„ P .. f' l-om+narwcaith o adsac _`�' _ � ° Official Use Only _ iP (�2 (y �/ ; _► _f sParfinan�o��iro�srtritsd Permit No. r - t%t > '-:. �,/ BOARD OF FIRE PREVENTION REGULATIONS I •Occupancy 07cy and Fee Checked �_ APPLICATION .FOR,PERMIT TO PERFORM , • eave blank All work to be performed in accordance with the Massachusetts Electrical ELECTRICAL WORK (PLEASE PRINT IN INK OR TYPE ALL INFO c,527 C z. City or Town of: kMATION Date: � ARMOUTH . By this application the undersigned gives notic of his or her intentionto perfothe e Inspector Location(Street&Nuf lies: er) T described below. Owner or Tenant ' i , • (4 Owner's Address Telephone No. Z. Is this permit in conjunction with a bu'ding permit? Yes Purpose of Building 1•A „` \ — N... , (Check A ppropriate Be )x Existing Service Utility Authorization No. Amps / Volts New Service Overhead 0 Undgrd 0 No, --o Meters Amps _�^Volts Overhead --� �- Number of Feeders and Ampacity 1 Undgrd No,of Meters _ • Logton and Nature of Proposed Electrical Work: N �l No.of Recessed Luminaires Completion a the ollowin_-table m. be waived b the Ins.ector of Wirer• �J No.of Cei1.,Susp.(Paddle)Fans No•of No.of Luminaire Outlets Transformers Total S • No.'of Hot Tubs KVA No.of Luminaires Generators KVA l Swimming Pool Above `o.o mergency g Ling No.of Receptacle Outlets Arnd. ❑ In- ❑ Battery Units J No.of Oil Burners • No.of Switches FIRE ALARMS No.of Zones 'No,of Gs Burners p�`o,of Detection and No.of Ranges Initiatin. Devices No.of Air Cond. °n . f":-.5 No.of Waste Disposers eat Pump _, umber Tons No.of Alerting Devices Tons--"�W""' o.of .elf-Containe, Totals: na Detection/AIecti No.of Dishwashers Devices Space/Area Heating KW• Local 0 Municipal No,of Dryers Connection Heating Appliances No,of ater KW Security Systems:* Heaters KW INo o o.of No•of Devices or E.uivalent n3t2 Wir,P-: Signs Ballasts e• \� No. Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent �_- Estimated Val Ele al Work.: Attach additional detail i desire Work to Start` ---------____, (When required by municipal policy.) required by the Inspector'of Wires. (i„,,. Work to N pections to be requested in accordance with GE COVERAGE: Unless waived byMEC Rule 10,and upon completion. INSURANCE licensee provides proof of liability insurance including the owner,no permit for the performance of electrical work may undersigned certifies that such coverage is in force,and has exhibited proof of samey issue unless g"completed operation" to thee or its substantial equivalent. The 2 s y� CHECK ONE: INSURANCE to -/ I certi '-- CE Y-x BOND ❑ OTHER X(Speci i„�c permit issuing office. fy, under[ r_ r� Lk) 3 � FIRM NAME: WAYNE SCHMIDT y,that the information on this �}� icati�n ELECTRICIAN is true and complete. Licensee: 222 WILLIMANTIC DRIVE (Ifapplicable,enteMARSTONS MILLS, MA LIC.NO.: � ��q PP 02648� liignatu —_— t Address: (508) 428-7747 'ne.) LIC.NO.; j "Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Sa Bus'Tel.Lic. o. �—"— OWNER'S INSURANCE WAIVER: Alt.Tel.No.: ��' �/ S by law. ByI am aware that the Licensee does not have the liability insurance overa a n�'o t Owner/Agent my signature below, I hereby waive this requirement. I am the(check one [] Signature g nnally owner ❑owner's a•ent�' Telephone No. PERMIT FEE: $