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Home My WebLink AboutE-19-547 o. Commonwealth of Official Use Only AE Massachusetts Permit No. BLDE-19-000547 •�:,� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.l/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:7/27/2018 City or Town of: YARMOUTH To the Ins sector of Wires: By this application the undersigned gives no we o us or her in en ion o per orm is a ec nca rk describ l€. i y. Location(Street&Number) 35 PHEASANT COVE CIR Owner or Tenant MCDONOUGH PAUL V 1 Telephone No. Owner's Address MCDONOUGH KATHERINE M, 15 MARLBORO ST,NORWOOD,MA 02062 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Receptacle for fire place blower. 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 0 ln- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and ,Inrtiatine 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 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 Data Wiring: Heaters Siens Ballasts 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: KEVIN A CRONIN Licensee: Kevin A Cronin Signature LIC.NO.: 11275 Qf applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:238 SHERI LN,S WEYMOUTH MA 021901254 Alt.Tel.No.: "Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"5"License: OWNER'S INSURANCE WAIVER:I am aware that the License does not have the liability insurance coverage normally required by law.But 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 `J Olt 0 Commonwealth el r//MaaeachulelL2 Official Use Only CommonweaCth ^ :0---2, -- t cc77 Permit No. ' 1 pt E Theparin and o/Jiro�eraiece Jr;l Occupancy and Fee Checked . ` s 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 / 2.2 / / $ City or Town of: \�GV IVI 0 0.14 To the Inspector of Wires: By this application the undersigned�lgives notice of his or her intently to perform the electrical work described below. f / Location(Street&Number) G•3 B(tt55 River MOIUV Stiv4-h LCAin o+4k IhA 0266 `t Owner or Tenant I !)O VI MrnAM-ATO Telephone No. 6nc63yc600g6 Owner's Address Wk �// Is this permit in conjunction wi a building permit? Yes ❑ No �+' (Check Appropriate Box) Purpose of Building lWQIIiij I Utility Authorization No. Existing Service_ Amps / Volts Overhead❑ Undgrd❑ No.of Meters• __ New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity J ,1 Location and Nature of Proposed Electrical Work: Cole d tr rr et yl ti A l( 14rAit d i eV- • . ins+-cl l Completion of the following table may be waived by the Inspector of Wires. otal No.of Recessed Luminaires No.of Ceil:Sus . Paddle Fans No.of TVA P (Paddle) Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting • grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones aa No.of Switches No.of Gas Burners No.of-Detection on Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number_ Tons K_W_ No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers CoSpace/Area HeatingKW Local 0 Municipal 0 Oth PConnection er * No.of Dryers Heating Appliances KW Security Devices No.of Dor Equivalent No.of Water No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.II dromassa eBathtubs No.of Motors TotallIP 3elNo.ofDeiicesorEns quival y gNo.of Devices or Equivalent OTHER: v Attach additional detail if desired,or as required by the Inspector of Wires. ^ Estimated Value of Electrical Work: (When required by municipal policy.) V ' Work to Start: 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 —I— the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverageais in force,and has exhibited proof of same to the permit issuing office. c• ty�t CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information`ton this application Is true and complete. FIRM NA rF toriusLOW Pc.I r j5lp(, o IteF ��(/�� l•Q ►AL' • LIC.NO.: `__ 1 C— ("I, Licensee: Nati/(2-0 M 2U1(ty Signature �L(/ LIC.NO.:9/87`7. to (lfapplicable,ent' "exem.t"in the?cense number line.) / Bus.Tel.No.•SGS 39q•77� .�,. O, Address: : "17G.lON ifCIP U- 4 :me lir 1-] 0 6� Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security wor requires Department of Public Safety"S"License: Lic.No. r OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally JD t(- required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. ^> S Owner/Agent Signature Telephone No. PERMIT FEE:$ 1 79G • ,,,,,,VIirn ..n& V' {.J 4JJNYIi flO...., A - w�Sis Department of Industrial Accidents 4=cli rip_= Office of Investigations is_;,�ii= 600 Washington Street • Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name(Business/OrggIanization/Individual): E.c.Wtrrv$lOvi �Ur`.bi� K O<t-kin. a, \e.) l i( . Address: $ KPodtvi C aTAP City/State/Zip: Sass t\ Ycre,c3,kn NPc Phone#: 'SDS-394-1'17ld Are you an employer?Check the appropriate box: Type of project(required): Xam a employer with 70 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 0 I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions t•0 I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' comp. insurance required.] 13.0 Other \ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. • Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. isurance Company Name: rksko.A 7,fCnrtAn(-9_ (Tha ttkrt.1 olicy#or Self-ins.Lic.#: I S a I A ,1 Expiration Date: I'—[ — a019 ib Site Address:a3 w2u-14'h /My CFgg� 1 II City/State/Zip: Da'4 to7 ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a foe f up to$250.00 a da a ainst the violator. Be advised ti.t a copy of this statement may be forwarded to the Office of tvestigations the DIA for insura.• overage veri aon. do hereby certify un e ains a /penalties o p•jury that the information provided above is true and correct. lanai&T • Date: Ia13l 1 a017� hone#: Stj`d:3SM• '1778 Official use only. Do not write in this area,to be completed by city or town official. • • City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other • Contact Person: • Phone#: