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Home My WebLink AboutBLDE-23-005645 kit 4/0 Commonwealth of Official Use Only � i Massachusetts Permit No. BLDE-23-005645 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRey.1/07J 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:4/10/2023 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) 70 CAPT LOTHROP RD Owner or Tenant CHESNUT KIMBERLY ANN Telephone No. Owner's Address CHESNUT BARBARA LEIGH, 70 CAPT LOTHROP RD, SOUTH YARMOUTH, 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. grad. 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 Ballasts Data Wiring: Heaters Signs 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 ❑ (Specify:) 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,1 hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 QLc 9/0,7,t3 2 . F,,,,,c4_. c Wee-7____*6f-cf- Commonwealth o/Mai.achweal Official Use Only ►� i t [t cc/� Permit No. i 3 —_ S�p-t S '_ �' ,=• .2 epart`rnenf o/.ire Seri/lc-el u: 4.... Occupancy and Fee Checked .�=F BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07 ) z,4:,0 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C , 27 C 1 (PLEASE PRINT IN INK OR P ALL INFORMA ION) Date: City or Town of: ' Q(` To the Insbector of Tres: By this application the undersigns rues notice of h's or her me to perform the electrical work described below. Location(Street& u ber) (-1 C_,fl / /Li AN es c Owner.or Tenant \ 1L'1 4 V t ( I Telephone No. 1 , Owner's Address Is this permit in conjunction with a building permit? Yes ❑ NO (Check Appropriate Box) Purpose of Building D L-k' ,\, \ A Utility Authorization No. Existing Service Amps / Volts Overhead Ell Undgrd n No.of Meters New Service Amps / Volts Overhead❑ Undgrd n No.of Meters Number of Feeders and Ampacity L cation and Nature of Proposed Electrical Work: GO 1.—rc., (j L-& ,e v.f G-f i o L• _r^ Completion of thefollowing_table may be waived by the Inspector of Wires. 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. nd. Batts Units No.of Receptacle Outlets No of Oi 11nrners ; FIRE ALARMS No.of Zones � No.of Switches No.of Gas Burners No.of Detection and Initiating Devices • No.of Ranges No.o Air Cond 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❑ Municipal ❑ Other Connection HeatingSecuritySystems:* No.of Dryers Appliances KW No,.of Devices or Equivalent No.of Water KW No.O1 No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydroarassage Bathtubs No.of Motors Total HP Telecommunications firing: I No.of Devices or Equivalent OTHER: • Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Va1tle Electric 1 Work: _ (When required by municipal policy.) Work to Start: ff � 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 coverage is in force,and has':xhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and na ies ofperiurv,that the inform tion.on this pr ation s true and complele„�3�n7 FIRM NAME: WAYNE SCHMIDT ' LIC.NO.: ELECTRICIAN Licensee: 222 WILLIMANTIC DRIVE Signature LIC.NO.: (If applicable,erne.MARSTONS MILLS, MA 02648 Address: (508)428-7747 Bus.Tel.No.: OCf 73 j�17/ Alt.Tel.No.: j� *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 El owner's,agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 5L