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Home My WebLink AboutBLDE-22-003355 Commonwealth of Official Use Only a Massachusetts Permit No. BLDE-22-003355 t.• �� 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:12/13/2021 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) 207 STATION AVE Owner or Tenant Scott Murdoch Telephone No. Owner's Address MA 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 Total 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 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. Toot l No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices Space/Area HeatingKW Local 0 Municipal 0 Other: No.of Dishwashers P Connection HeatingAppliances KW Security Systems:*ances No.of Dryers PP o.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent Telecommunications Wiring: No.Hydromassage 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 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 LIC.NO.: 33699 Licensee: Wayne B Schmidt Signature Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) Alt.Tel.No.: Address:222 WILLIMANTIC DR, MARSTONS MLS MA 026481929 *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. I PERMIT FEE: I $50.00 l"l �� S r 'W '_ex. ___Z__ KG3Ltr-6— /� ��!/ �///j� Official Use2 Only i lAmmonweatlh o� assac�iu�¢ff� Petmit No�7i7i� J � b = 'ell 2)epartmant o/ ire ervice! • - Occupancy and Fee Checked �; -==,�/ BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 7 CM 12.00 (PLEASE PRINT IN INK OR P ALL INFOR ION) Date: l City or Town of: INs O(I To the Inspector of Wires: By this application the undersi gives notice of is�r he n iio perform the electrical work desc,ribed below. � Location(Street&Number) �. J(�J-tv►•p `'f�2 Owner"orTenant Seal it 114()� �' yn ` Telephone No. Owner's Address . Is this permit in conjunction with a building permit? Yes ❑ Noo (Check Appropriate Box) Purpose of Building D -e X\ \A —Utility Authorization No. • Existing Service Amps • / Volts Overhead D. Undgrd❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Ampacity _ , ��, t _ L cation and Nature of Proposed Electrical Work: GO1�,, Ze p t-A_c.e viel f,.i G- DO i Le . V Completion of the following.table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In-' No.of Emergency Lighting • No.of Luminaires Swimming Pool grnd. ❑ grnd'. 0 Battery Units No.of Receptacle Outlets No.o OH Rurners FIRE ALARMS No.of Zones -I NO.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.o it i_.on . Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained • No.of Waste Disposers Totals: ' «� . Detection/Alertin$Devices . OtherNo.of Dishwashers Space/Area Heating KW' Local❑ Municipal Connection �__ Heating Appliances KW, Security Systems:* No.of Dryers No,of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent • 'Telecommunications Wiring.: No.Hydromassage Bathtubs INo.of Motors Total HP No.of Devices or E uivalent OTHER: co AA S Attach additio►ial detail if desir ,or as required by the Inspector of Wires. Estimated Value o Ele trical Work: (When required by municipal policy:) . Work to Start: 1��11Zl 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'xhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEaBOND ❑ OTHER 0 (Specify:) • I certify,under the pains and na es.ofperiurv,that the inform Lion,on this %,pl'j ation true and completoi„3"-q r} FIRM NAME: WAYNE SCHMIDT .� LIC.NO.: ��ii ``�1 ELECTRICIAN g Si nature I LIC.NO.: Licensee: 222 WILLIMANTIC DRIVE _ of applicable,ente.MARSTONS MILLS, MA 02648 , Bus.Tel.No.• Qg. 737071 Address: (508)428-7747 Alt.Tel.No.: G7 *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 a'nt. Owner/Agent Signature Telephone No. I PERMIT FEE: $