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Home My WebLink AboutBLDE-23-004501 qi.O Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-004501 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) 28 COTTAGE DR Owner or Tenant LANDON LAVERTY Telephone No. Owner's Address 28 COTTAGE DR,WEST YARMOUTH, MA 02673-3514 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&add on A/C. 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. 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 ❑ 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: 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) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 &( c - �` !,0 c.,,,.. 50 LIIt- `,2) c--,,S, Commonwealth of a45achuoJ 3 Official Use Onlyu ! Permit No.�=-l3 ' Q l�_ „ Japa�f,u,t oi.eirQ scrvi s _ fM1- .: BOARD OF FIRE PREVENTION REGULATIONSOc` 'az"y• and Fee Checked -- ' rev. 1/07] eave blank) APPLICATION FOR:PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical f v (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I t9� City or Town of: A�j�/jOUTH ._.__ '� By this application the prtdersign iv notice of his •r her intention to performthereCaicalr v�vfordescribed below. • • Location(Street&Number) i °` { Owner or Tenant Lit- a - , —.T �'�, ,,_, Telephone No. / ' x Owner's Address Is this permit in conjunction with a bu'ding permit? yes Purpose of Building ` \1�a —' N0 o (Check Appropriate Box) Utility Na.._._....___________________titRn►7:uticr4 Existing Service Amps / Volts Overhead v ❑, Undgrd� No.of Meters New S` Amps / Volts Overhead Number of Feeders and Ampacity • Aft El Undgrd El No.of Meters Loation and Nature of Proposed Electrical Work: _ M • _ it:_-__ 'i� '"IV�r"® J 1 r tea „-t. Com letion o the ollowin table m be waived b the Ins ector of Wires. No.of Recessed Luminaires No.of ceil.�usp.(Paddle)Fans No, s Total No.of Luminaire OutletsTransformers KVA No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above In- 0.o mergency g tang t: d,• ❑ arnd, ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners o.of Detection and No.of Ranges ut• Initiatin Devices • No.of Air Cond, Tons No.of Alerting Devices No.of Waste Disposers eat Pumpumber Tans W Totals: ._--- __ o.of elf-Containe No.of Dishwashers _ Detection/Alertina Devices Space/Area Heating KW Local 0 Municipal No,of Dryers Connection 0 Other r3 Heating Appliances KW Security Systems:* No.of ater No.o No.of Devices or E uivalent Heaters KW o, of Data Wirin Signs Ballasts No.or ng,, n E_ No. Hydromassage Bathtubs ` c.,, v= u+relent No.of Motors Total HP Telecommunications Wiig: OTHER: No,of Devices or E uivalent Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: k (When required by municipal policy.) Inspections 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. ONE: CHECK INSURANCE BOND r � I HECK, under t' - "- ❑ OTHER.(Specify:) W O cKe s FIRM NAME: WAYNE SCHMIDT 35 that the information on this icati n is true and complete ELECTRICIAN LTC.NO„ 6qcio Licensee: 222 WILLIMANTIC DRIVE (If Licensee.applicable, nt ARSTONS MILLS, MA 02648_... Signatu I LAC.NO.: Address: (508)428-7747 ne.) _________� • Bus.Tel.No.: �/7/ J *Per M.G.L. c. 147,s.57-6 1,security work requires Department of Public Safety S"License: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normallyS required by law. By my signature owner below, I hereby waive this requirement. I am the(check one ❑ o t Owner/Agent .o_____—. � ❑owner's a ent.Signature oi Telephone No• PERMIT FEE: $ �