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Home My WebLink AboutBLDE-22-004589 Commonwealth of Official Use Only 000 Massachusetts PertnitNo. BLDE-22-004589 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:2/17/2022 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) 10 LOOKOUT RD Owner or Tenant JARVIS MICHAEL Telephone No. Owner's Address JARVIS LINDA, 110 CLUBHOUSE LN, NORTHBRIDGE, MA 01534 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 Initiatine Devices No.of Ranges No.of Air Cond. Ton l 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 ❑ 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 Eauivalent 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 Casa 7 S . ,A . e _ c , • Commonwea/g of massachudeu1 Official Use Only �_ 2c� c7 n ej22 .45 Mi-=Ft Pemut No. J )eparfinenE ol}ire Serviced --:--Ti-_- 1 Occupancy and Fee Checked • i--=- BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) .,JVa, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical 9ide7n3,c )27[) l 2 00 (PLEASE PRINT IN INK OR P ALL INFOR .ION) Date: , , City or Town of: > w10 t'I To the Inspector of Wires: By this application the undersign 6ves Ice of his or her intention to e o the electrical w rk described below. . Location(Street&Number) ° Pr r'�}-- s �— Owner or Tenant 1 �� Telephone No. S P 7/Y 5/ Owner's Address • Is this permit in conjunction with a bt uilding permit? Yes Ell No' (Check Appropriate Box) Purpose of Building Li-e A\ A Gfi Utility Authorization No. - -Existing Service - Amps- -/ _ --Volts - Overhead 0 -Und rd g � No.of Deters New Service Amps I Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity L• cation and Nature of Proposed Electrical Work: l,ill 11-•� e p L&c.e oel-yd- • o i Le-le` t Completion of the following table may be waived by the Inspector of Wires No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans T 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.o uLpgr`_ FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiating Devices • No.of Ranges No.o Air iron . Tons 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❑ Mpnunicipalion ❑ Other Cystems:* aect No.of Dryers . Heating Appliances KW Sec No,of Devices or Equivalent _ No.of Water No.of No,of Heaters KW Data Wiring: H Signs Ballasts No.of Devices or Equivalent • No.Hydrornassage Bathtubs No.of Motors Total HP Telecommunications Wiring: -No.QfDevices_or_Equivalent OTHER: • Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of lec a Work: (When required by municipal policy:) Work to Start: lbA2_ Inspections 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 BOND ❑ OTHER 0 (Specify:) • I certify,under the vain and na es ofveriurv,that the inform lion,on this 'pl';ation true and complete //'' Q'FIRM NAME:_ WAYNE SCHMIDT P / ' LIC.NO.:complete.....,„„ l Licensee: ELECTRICIAN ��JJJ��!!!I ' 222 WILLIMANTIC DRIVE Signature LIC.NO.: Of applicable,ente.MARSTONS MILLS, MA 02648 - Address: (508)428-7747 Alt.Bus.Tel.No.: O� j'J� f/ *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S".License: LiTc.No.•• �J 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/Agent ❑ El owner's agent. Signature Telephone No. I PERMIT FEE:$ SO I