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Home My WebLink AboutBLDE-23-002472 Official Use Only aF ,,,,,,,,,..,,A,_, Commonwealth of E` i Massachusetts Permit No. BLDE-23-002472 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:11/6/2022 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) 18 DAISY LN Owner or Tenant BROUTHERS ROBERT R JR Telephone No. Owner's Address BROUTHERS BRIAN, 18 DAISY LN, SOUTH YARMOUTH, MA 02664 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 HVAC&add sub panel. 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 Tonal No.of Alerting Devices 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 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 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 4,- ,, c,kGr_s_ i_33_______.1''- re_c:3 ij 4_, = = Co'nmonweaig of/rtaJJachuJat 1 • Official Use Only `�'`== -5-ZL 7 7/, - 1= - 2epartmant Permit No. =•=�_ � o�Jiro�arvicaJ =-f Occupancy and Fee Checked s-:,,�;�.r BOARD OF ARE PREVENTION REGULATIONS [Rev. l/07] • --- (leave blank) • APPLICATION FORPERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: l 073 I I 2 Z City or Town of: YAR1VIOUTH To the Inspector of Wires: By this application the undersigned ives otice of his or her intention to perform the electrical work described below. • Location(Street& tuber) S" L Owner.or Tenant ()be cr. 0 I J�I � Telephone No. Owner's Address �/' 1w L Is this permit in conjunction with a bu"ding pIZI( � � El No (Check Appropriate Box) Purpose of Building D V�.1 ` ,nermit? Yes, \ i \-3 Utility Authorization No. Existing Service Amps / Volts Overhead ❑. Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd l; ❑ No.of Meters Number of Feeders and Ampacity ' Lo ation and Nature of Proposed Electrical Work: fur N ND ,° � -V � 1Se by _ �� f� Completion of the following table may be waived the Inspector of Wires. No.of Recessed Luminaires Na,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.oft Emergency Lighting arnd. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners moo.of Detection and Initiating Devices No.of Ranges No.of Air Cond. To sl No.of Alerting Devices No.of Waste Disposers Heat Pump l Number Tons W No.of Self-Contained ' Totals:I �� - K-- -' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ � No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No. of No.of Heaters KW 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 desirec4 or as required by the Inspector of Wires. Estimated Value of Ele 'cal Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C GE: 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. CHECKONE: INSURANCE 1g BOND ❑ OTHER X(Specify:) Lio cKe-s C owl) Icerti , under t°------- -- -' ----'-- -`- WAYNE SCHMIDT S''that the information on this icati n is true and complete. FIRM NAME: ELECTRICIAN l �i'� 222 WILLIMANTIC DRIVE A j LIC.NO.: y Licensee: MARSTONS MILLS, MA 02648____ Signatuk �` (If applicable,ente LIC.NO.: (508)428-7747 'ne.) ---- Address: Bus.Tel.No.: 17/ Tel. J "`Per M.G.L. c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt Lic. No.. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage n�— S required by law. By my signature below,I hereby waive this requirement. I am the(check one)[]owner ❑owner's agent_ 7 Owner/Agent I Signature Telephone No. I PERMIT FEE: $`� J l