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Home My WebLink AboutBLDE-22-003528 ....- Commonwealth of Official Use Only Permit No. BLDE-22-003528 .;1 Massachusetts 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) D a te:12/26/2021 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) 12 TASMANIA DR Owner or Tenant VAN WICKLE GLENN C Telephone No. Owner's Address VAN WICKLE SHARON M, 12 TASMANIA DR,YARMOUTH PORT, MA 02675-2156 0 Is this permit in conjunction with a building permit? Yes 0 No 0 (Chec prr 1 Purpose of Building Utility Authorization No. <JCJ . Existing Service Amps Volts Overhead 0 Undgrd 0 o , i .to New Service Amps Volts Overhead 0 Undgrd 0 , Number of Feeders and Ampacity O 4417 Location and Nature of Proposed Electrical Work: Replacement HVAC. ?- Completion of the following table y ed b I i ' or of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of `Yt •1 Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grad. 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 TTotal 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 0 Municipal El Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent 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 CK6r: ,...:e...,---.5-a C,ommonrusa of 2 assachu4c ,. Official Use Onl Pa 1.!/ it-- i .2aparfineni on ire� Permit No.�� _� o crs arvtcss BOARD OF FIRE PP'�VENTION REGULATIONS Occupancy and Fee Checked ' ,-- - - {Rev. 1/07] • —'-- (leave blank) APPLICATION FORPERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical C c C),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ' City or Town of: YARMOUTH To the Inspector of Wires:By this application the pndersi e fives n tice of his or her intention to perform the electrical work described below. Location(Street&Number) i �J� Owner.or Tenant t (_ Telephone No. .12s Owner's Address �' e ,ot Is this permit in conjunction with a bui ding permit? Yes ❑ No, � (Check Appropriate ppropriate Box) Purpose of Building D CW�.\, \ fin A Utility Authorization No, Existing Service Amps / Volts Overhead D. Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity Lotion and Nature of Proposed Electrical Work: 11111 t Co pletion 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- 0 No.of It mergency Lighting eri►d grn 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. Ton • Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number ns KW No,of Self-Contained ' To Totals:I �'-"- �" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local❑ Connection Municipl a ❑ Other No.of Dryers Heating Appliances KWSecurtty Systems:* No.of Water No. of No.of No.of Devices or Equivalent Heaters KWData Wiring; Signs 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 E ecical W rk 1 (When required by municipal policy.) Work to Start: 1 pections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: Unle s 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 X BOND 0 OTHER S ci ( C" ' t I certify, under t'----°--- ---�-----'--'— -`_ _ Jc-�.( Pe �'�) W(Jo��'� FIRM NAME: WAYNE SCHMIDT 7,that the information on this Oicati n is true and complete. ELECTRICIAN LIC. Licensee: 222 WILLIMANTIC DRIVE - �- �_---= ---MARSTONS MILLS, MA 02648 Signatu ///��' LIC.NO.: (If applicable,ente (508)428-7747 'ne.) Address: Bus.Tel.No.: -- `� j Per M.G.L.C. 147,s.57-61,security work requires Department of Public Safety"S"License: LiAlt c. No„No. �1J7 - OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�— required by law. By my signature below, I hereby waive this requirement. I am the(check one ❑owner ❑owner' ent. 7 Owner/Agent l`l Signature Telephone No. ' PERMIT FEE: $