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Home My WebLink AboutBLDE-23-001569 Commonwealth of Official Use Only Massachusetts ,Permit No. BLDE-23-001569 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.l/073 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:9/26/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of Ins or her intention to perform the electn'c1 work described below. Location(Street&Number) 37 CHURCH ST Owner or Tenant DON BOURNE 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 0 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: Wiring for two head split system. 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 Initiatine Devices No.of Ranges No.of Air Cond. 2 Tn Total 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 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 Sinus 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:1 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) Cl owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 - r _ All ( W...i........„„ L. - " 3G 1-'- . . Commonwealth. ol Maddachudeito . ' . Official Use Only i - t , - '� =- e artmer ogirePermit No. 3 �( gO 0 ^_ . BOARDp ��RE pREVENTloN REGULATIONSOccupancy and Fee Checked :, -,.' [Rev. 1/07] (leave blank APPLICATION.. � PERMIT TOA1I 'work to PE1FoRM ELECTRICALbe performed in accordance with the assachusettsElectrical � (PLEASE PRINT IN INK Q ' A Ar i) L 9 Code (MEC), 527 C1Vr1� 12.00 • /- ; Date: City or Town of: ilhath.A. ' ' 0 ,� '; %� • • By this application the undersign- : :Ives notice = ,.._. To the 1'nspectoY o,f y�w�'�•es; of his or her ntentxon to perform the electrical work described Location (Street & Number) 3LtujAbed below. Owner' 1 �� -- �: - or Tenant ' '�1 � 's 5v' r►_ Telephone Address phone No. Art 0 . . Is this permit in conjunction with a buildingpermit? Yes Li No Fl (Check ° Purpose of Building � �,` 11�s�' 1 C � Appropriate Box) Utility A thorization No, .Existing Service Amps / .....,.. Volts Overhead [, Undgrd NEl No, of 11Ierers ew Service Amps / Volts Overhead ri UndgrdU Number of No, of Meters Feeders and Ampacf�Y ,,� r-, , ip k ( Lee' lion and Nature of pro ose • ' • d Electrical Work: or sps _._ . - to -:.-- ,S ' - . • _......._,..._ 't Completion o f'the, 'bllowin table ma be waived by the Its ector o No. of Recessed Luminaires No. of'Ceil Suspa (Paddle) Fans • o, o of Wires, Total • 'Transformers KVA, No, of Lucrninaire Outlets - No. of Hot Tubs • Generators KVA ' No. of Luminaires SwimmingAbove o. o m pool 'rnd. 0111w I rod; ❑ • g icy Yg � mg Batter Units No. of Receptacle Outlets No. of Oil � � � � — . . . Burners FIRE ALARMS No• of Zones No, of'Swrtches No, of o. o e Gas Burners Burners • , tection and No. of Ranges 3:".".."7"--1--."----w."..-M--ft-a------4--A---------m .4 ZnYtYatinnevrces of Air Cond• • Tons ,No. of AlertingDevices No. of Waste Disposers cat um umber ons .,.�,_ es Totals: No. of Self-Contained Detection/Alertin Devices No, of Dishwashers Space/Area Heating �' �" focal (�. MuYxicxpa �• steConnection ED Other No, of Dryers Heating Appliances Y{ ecurYty ms:• "�""'`' ` No. of No. ol~`��Yater moo• ofDevices or Equivalent Heaters Y{'�4� I_Va, of +� Si ns ballasts .+va. , r :i algb• No. of Devices or Equivalent • No. Bydrornassage Bathtubs No, of Motors T Telecommunications 'f'�irx •Total HP n OTHER: No, of Devices or Equivalent Estimated Value o : lectri• al Attach additional detail Vf desired, or as requited by the Inspector ector of • Work, h Wires. (When required by municipal policy.) Work to Start: �-- Inspections to be requested in accordance with MEC Rule 10, and upon completion.YNSURANCE CO Unless waived by the owner, no permit for the performance of electrical work the licensee provides proof of liability insurance including "completed may issue unless • pleted operation" coverage or its substantial equivalent, The undersigned certifies that such co erage is in force, and has exhibited C�l'✓C� ONE: proof of same to the permit issuing office, INSURANCE BOND 0 OTHER 0 (Specify:) 1' certi.fy ur ... ....... ......"...... .. ., C p fY "1 "••'"' '•'tat the information on this application is true andr FIRM NAI WAYN E SCH M I D`i' currtpletc • . �� ELECTRICIAN .'� �' �� 222 WILLIMANTIC DRIVE Nitc ,v) 1LIC' NO• ._,� '. o .)Licensee: _ MARS Si nature ' (I a licabl� TONS MILLS, MA 02648 g ' EYC. NO.: f pp (508) 428.7747 Address, Buy. Tel. No• _ 37.217i `Per IVi•G•�,, c, 147, s. 57-6 1 , security r Alt. ' 'el. Igo :�, ty work requires Department of public Safety "S" License: Lic OWNER'S INSURANCE WAIVER: I am aware that the Licensee doesliability � No' not have the insurance coverage normally required by law. By my signature below, I hereby waive this requirement, X amthe Owner/Agent (the ck one o vvner 0 owner's agent, Signature Telephone No. F, 1x7" , `, ' 1 E, $ J \ „v •••. - - f