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Home My WebLink AboutBLDE-20-002216 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-002216 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•10/21/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice or his or her intention to perform the electrical work described below. Location(Street&Number) 134 WATER ST Owner or Tenant STAUDENMAYER MARY ANN S TR Telephone No. Owner's Address M A S STAUDENMAYER REV TRUST, 134 WATER ST,YARMOUTH PORT, 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 boiler. 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 Initiating 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/Alerting 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 Data Wiring: Heaters 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 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature b ;?iTelephone No. PERMIT FEE: $50.00 Øii F C kG-23tf_t"" - _ Commonwealth of'f a.mac etas al-CO Use Only i•---ff.- =_�t c� t c-i �`7 Permit No. / J ZZ'I =�1 t .: )e lartmenf of Jire Services -� Occupancy and Fee Checked _: F' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071, (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 27 CMR 12.00 (PLEASE PRINT IN INK OR P ALL INFOR ION) Date: to l 16 I CC City or Town of: ��0 v To the Inspector of Wires: . By this application the undersign ves notice of his or her intention to perform the electrical work described below. Location(Street&Number) ' r Y'ft.1 Owner.orTenant 13 i11 �e'etwae A Vtt '. — Telephone No. 3 C 7 1,13-3 Owner's Address Is this permit in conjunction with a building permit? Yes n Noo (Check Appropriate Box) — - -Purpose of Building )W-e,. \ 't In Utility Authorization No. Existing Service Amps / Volts Overhead 0. Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd n No.of Meters Number of Feeders and Ampacity cation and Nature of Proposed Electrical Work: COi�'ti, .p L kce vv' r.� �i oiLe_r Completion of the followingtable 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 swimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.o Oil Run] r FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. Initiating Devices No.of Ranges No.o it..on . Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: — Detection/Alerting Devices No.of Dishv,ashers Space/Area HeatingKW• Local❑ Municipal ❑ � P Cyyonnection No.of.Dryers Heating Appliances KW Security No, f Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent • Tetecommunications Whing: No.Hydroinassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: - Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lectric 1 Work: (When required by municipal policy) Work to Start: t Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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 coverageve� is in force,and has'xhibited proof Of same to the permit issuing office. CHECK ONE: INSURANCEdl liBOND ❑ OTHER ❑ (Specify:) - • I certify,under the nains and na ofperiurv,that the inform ' non this ' pli ation true and completes FIRM NAME: WAYNE SCHMIDT P LIC.NO.: f ELECTRICIAN Licensee: 222 WILLIMANTIC DRIVE Signature LIC.NO.: (If applicable,ente.MARSTONS MILLS, MA 02648 , Address. (508)428-7747 Bus.Tel.No.: Alt.Tel.No.: O 1� *Per M.G.L. c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. , OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature — Telephone No. - 'PERMIT FEE:$ 6.6