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HomeMy WebLinkAboutBLDE-23-001766 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-001766 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:10/4/2022 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) 205 WHITE ROCK RD Owner or Tenant COOPER RYAN M Telephone No. Owner's Address COOPER ELAINE R, 205 WHITE ROCK RD,YARMOUTH PORT, MA 02675-2369 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 ❑ 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 Siens 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 ❑ (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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 c/kG___-4- - -ee-50 Commonwealth.of///asaactsu4aft! • Official Use Only "= IM='t c723 —l 7/�� ` - �,_ Apartment �` s Permit No. �P _� o K' ervices '- tit-— `==( Occupancy and Fee Checked --;- ---, BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] . (leave blank) APPLICATION FOR-PERMIT TO PERFORM ELECTRI AL WORK All work to be performed in accordance with the Massachusetts Electrical C 91527 ..\op-2...... (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: YARMOUTH To the Inspe tor of Wires- . By this application the Imdersignml gives notice of,,iis or.hcr inten Aon to pe the e ectri o described bel • Location(Street& mber) ,© ' C '� ra` Owner.or Tenant 4, IA r � -- 1(04 Telephone No. i • Owner's Address ...c, P-J~ Is this permit in conjunction with a bu ding permit? Yes ❑ No • f .t�\� (Check Appropriate Box) Purpose of Building D W \ \ Utility Authorization No, Existing Service Amps / Volts Overhead❑. Undgrd❑ 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: e 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 l!mergency Lighting • :rrnd. trod. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS [No.of Zones No.of Switches 0o.of Gas Burners No.of Detection and N Initiating_Devices No.of Ranges No.of Air Cond. ' Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons W No.of Self-Contained Totals: }'-�—'-�K'-- -' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW• Local❑ Municipal Connection ❑ e'er No.of Dryers Heating Appliances , Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No, Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Estimated Valu Attach additional detail ff desired or as required by the Inspector of Wires. o E ctn a ork (When required by municipal poIicy.) Work to Start: ,Inspections to be requested in accordance with MEC Rule 10, INSURANCE OV RA E: Unless waived by the owner,no permit for the performance of electrical work maytissue 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 BOND ❑ OTHER (S CO I certi , under t'- (Specify:) (�Ke ' (_ ' 1 FIRM NAME: WAYNE SCHMIDT 7',that the information on this icati n is true and complete � ELECTRICIAN � ���p� Licensee: 222 WILLIMANTIC DRIVE LIC•NO,: Ir'— �)-t2_�i/ --MARSTONS MILLS, MA 02648 Signatu (If applicable, ente (508)428-7747 'ne.) LTC.NO. Address: Bus.Tel.No.: �`— J *Per M.G.L. c, 147,s.57-61,security work requires Department of Public Safe S"License: Alt,Tel.No.: �'7/ <z OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n Lic, No. S required by law. By my signature below, I hereby waive this requirement. I am the(check one ❑owner 7 Owner/Agentnormally Signature ❑owner' ent Telephone No. • PERMIT FEE: $