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Home My WebLink AboutBLDE-23-003499 Commonwealth of Official Use only k1/4,L, Massachusetts Permit No. BLDE-23-003499 kE";� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked r, [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:12/27/2022 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) 100 WEBBERS PATH Owner or Tenant HAAG LISA ANN Telephone No. Owner's Address 144 CHAPPAQUIDDICK RD, EDGARTOWN, MA 02539 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: Wire replacement gas 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. 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 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 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: 12/21/2022 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 Mt.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 gi C(Ltlid ,....„... :------e . ---.R.c. D F Gi<. . . ....24_._:_-t---'' . ---------_F ,, _ . . • • Commonwealth o �� ,�ss aacLetth - Official Use Only of-y; -iii _ 't ThepaftriLefrd PermitNo.ol 3ire ervccei M_ •. Occupancy and Fee Checked y`�� I BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank) • - APPLICATION FUR 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 IIVIC OR P ALL INFORMA •ION Date: i 2 2:2- 1 -z-2— City or Town of: Y'10 (Tfl \ To the Inspector of Wires: • By this application the undersigns gives n ice of his or her intention o perform the electrical work described below. Location (Street & Number) OC+ t" `,, t 'l III A ... ...„=:, Owner.or Tenant L ` 4.ek(260erS ) • . Telephone No. • APF j Owner's Address . Is this permit in conjunction with a building permit? Yes n No (Check Appropriate Box) Purpose of Building D Li-e ,k \ \ A Utility Authorization No. • Existing Service Amps • / Volts Overhead U. Undgrd I I No. of Meters New Service Amps / volts Overhead i . Undgrd 111 No. of Meters Number of Feeders and Ampacity • L cationfLe,r and Nature of Proposed Electrical Work: riZ Le, . -e , � e v 19-•- • . - . Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans • To, Tot Trans formers KVA No, of Luminaire Outlets No. of Hot Tubs Generators KVA • Above In- • ' + • No. of Luminaires Swimming Pool grnd. Q grnd. Battery No. of Receptacle Outlets No, o rs ' • ' Zones r . t No. of Switches i No. of Gas Burners + + : • • + ' Initiatin I . • No. of Ranges No. o • ir ond. • Tons , No. of Alerting Devices No. • of Waste Disposers Heat Pump •Number_T Tons .•,�••.,••KW�� , No, of Self-Contained • p Totals: Detection/Alerting,Devices . _ No. of Dishwashers S ace/Area HeatingKW f Local• Municipal Other A El Connection o No. of Dryers . Heating Appliances KW Security Systems:* No, of Devices or E covalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent - yy �/ Telecommunications Wiring: �]!1 - ♦r.�f-::r:s•1cn• nra R.}th�. �.o No. of A�[.n.�..r+- Total H • . . H �:t• to'n2s ge Rathtt:bs N NV• Vf Motors s w otal HP I 1 No. of Devices or quivaient OTHER: I. Attach additional detail if desired, or.as required by the Inspector of Wires. Estimated Value of Eliectricai Work: (When required by municipal policy:) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and completion. ' upon P INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee proyides proof of liability insurance including "completed operation" coverage or its substantial equivalent, The • undersigned certifies that such coy -.rage is in force, and has r;xhibited proof Of same to the permit issuing office. CHECK ONE: INSURANCE is BOND ElOTHER 0 (Specify:) . . I certify, under the pains and e na ies.of perjury, that the inform (ion on this tpli ation s true and corrtplete . FIRM NAME: WAYNE SCHMIDT -' LIC. NO.: 3 ELECTRICIAN �" - Licensee: 222 WILLIMANTIC DRIVE _ Signature LTC. NO.: (If applicable, ente, MARSTONS MILLS, MA 02648 Bus. Tel. rlo.: - Address: (508) 428-7747 — - Alt. Tel. No.: •. *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) El owner Li owner's agent. Owner/Agent Signature . Telephone No. PEIWIT FEE: $ ,.3 r-,( �n��r _ ' - ' ' ' n�� - ' - `�^v ' . 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