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Home My WebLink AboutBLDE-23-001056 Commonwealth of Official Use Only • E` Massachusetts Permit No. BLDE-23-001056 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:8/29/2022 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) 26 FOREST GATE VILLAGE Owner or Tenant WILBUR WINTHROP V JR Telephone No. Owner's Address WILBUR NANCY K, 26 FOREST GATE,YARMOUTH PORT, MA 02675 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 condenser 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 rnd. 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 Initlatine Devices No.of Ranges No.of Air Cond. 1 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 ❑ 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 Euuivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 perjuty,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 �� 4th2'A Telephone No. PERMIT FEE:$50.00 C'C��-4 le.,.......,4 (Ykop , . Commonwe o/Maooachadetfd Official Use Only �� - �� 2epartment No. ail 2 epartment o/ ire serviced BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked „`' [Rev. 1/07] (leave blank) APPLICATION:FOR PERMIT TO PERFORM E ECTRICAL WORK All work to be performed in accordance with the •sachusetts Electrical C` . (PLEASE PRINT IN INX O' t L i . • ,. , ri Date: �lv�(t 12.00 City or Town of: g t� •OI I I. To the Inspector of Wires: By this application the undersi:,-. ,y e l l('es not ce of his or here ntentionteio to perform the e e trical work described below. Location(Street&Number) r ��•fi t` Y---• Owner'or Tenant 1t r Telephone No. Owner's Address ' Is this permit in conju t n w th ildin permit? yes ElNo . Purpose of Building �� d (Check Appropriate Box) • Utir • uthorization No, dS ingService Amps . / \'oits Overhead O. Undgrd❑ No,of Meters e Service Amps / Volts O ahead Undgrd Number of Feeders and Ampacity ri ❑ ❑ No,of Meters Location and Nature of Proposed Electrical Work: 4. ?çt .. Q4Y'\ 7fl A flY1tL Com letion o the ollowin table ma be waived b the Ins ector of Wires. o.o No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA - •• No.of Luminaires Swimming Pool grnAd e ❑ grnd. 0 No.ot Batteryme Emergency Lighting No.of Receptacle Outlets — - No.of Oil Burners FIRE ALARMS INo.of Zones No.of•Switches No.of Gas Burners l lo.ot`Detection and No.of Ranges Total Initiating Devices g No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Num ons KW .............. .. .,,-,„,,,,,,,,,,,,,,, No.of Self-Contained Totals:(' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW' Local 0Municipal Connection ❑ Other No,of Dryers Heating Appliances KW Security Systems:* No.of Water KW No.of No. No.of Devices or Equivalent Heaters of Data Wiring: Signs Ballasts No.of Devices or Equivalent • No.Hydromassage Bathtubs No,of Motors Total HP Telecommunications tarring: No,of Devices or Equivalent OTHER: Attach additional detail if desired;or as required by the Inspector of Wires. • Estimated Value Electrical Work: (When required by municipal policy.) Work to Start: Z2 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 co erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER 0 (Specify:) I eery at `•"-'-" --"---• • "-' •-••" "slat the information on this application is true and complete.FIRM NAI WAYNE SCHMIDT ° LAC.NO.; � ELECTRICIAN aattp-1 Licensee: 222 WILLIMANTIC DRIVE Signature Licensee:-l. MARSTONS MILLS, MA 02648 g LTC.NO,: • Address: (508)428-7747 r Bus.Tel,No *Ira if a . *Per M.O.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: LiAlt. e.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)0 owner 0 owner's a nt. Owner/Agent Signature • Telephone No. I PERMIT FEE:$ J