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Home My WebLink AboutBLDE-19-001680 Commonwealth of OffcialUse Only 1/.‘1) Massachusetts Permit No. BLDE-19-001680 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:9/20/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or tier intention to pertorm the electrical work described below. Location(Street&Number) 87 EILEEN ST Owner or Tenant MILL STEPHAN L TRS Telephone No. Owner's Address MILL SUSAN L TRS,87 EILEEN ST,YARMOUTH PORT,MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Miscellaneous work per attached. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 'No.of CeiL-Susp.(Paddie)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 No.of Detection and Initiation 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 ❑ 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 -Siena 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 ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ANDREW M LEVESQUE Licensee: Andrew M Levesque Signature LIC.NO.: 17318 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:461 LOWER COUNTY RD,HARWICH PORT MA 026461831 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 signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent Signat��ure��ii f/2-1 Telephone No. PERMIT FEE:$50.00 l � 4e t omrrtonwea o addac ace ^ per_' _ c c� c7 Permit No. �S_ \ e _ T e ariment of giro&rvicee IOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT ` t PE}roR ELECTF 1C L WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 • (PLEASE PRINT ININKORTYPE ALL INFORMA ION) Date:Of In- City or Town ofern U Urn- To the Inipector of Wires: By this application the undersigned notice of his or her' tention�perform the elec' ca work desc.Thed b�loyw. . Location(Street&Number) I ` A S ` A VIS. Owner or Tenant M LL_ Telephone No. & 3- t)4Lf- thos LI• Owner's Address • Is this permit hi conjunction with a buildin rreit2 Yes ❑ No34 (Check Appropriate Box) Purpose of Building PEN Utility Authorization No. • Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters Number of Feeders and Antipathy Location and Nature of Pro osed Electrical Work i I omple on oft allowing table may be waived by the Inspector of Wires. No.ofRecessed Lmndnalres No.of Celli.-Burp.(Paddle)Fans No.of Total Transformers KVA No,off Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above o In- No.of Emergency Lighting • grid grad. Battetylfnits No.of Receptacle Outlets No.of Oil Burners . FIRE ALARMS No.of Zones No.of Switches No.of Gas Bunters No.of Detection and Initiating Devices • No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No. ed of Waste Disposers BeatTotta P I N •umber Tons KW No.of Detection/AlertingngDevices No.of Dishwashers Space/Area Beating KW Local 0 Municipal 0 Other Connection No.of Dryers B�atingAppBances KW Security stems:* •No.of Devices or Equivalent No.off Water KW , No.of No.of Data Wiring: HeatersSigns Ballasts • - No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total BP Telecommunications Wiring: Na of Devices or Equivalent OTHER: • Attach additional detaillfdesirect or as required by the Inspector of Wires. Estimated Value ofElectrica�l Work: I-t( t/ - • (When required by municipal policy.) 'Work to Start: q /r i 4 Inspections to be requested in accordance with MEC Rule 10,and upon completion. • INSURANCE C GE: Unless waived by the owner,no permit for the peribrmance of electrical work may issue tmless 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 P BOND'❑ OTHER 0 (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application it true and complete • FIRM NAME:-I'f" liIC&p012T I'fFtlNb yCO HN6i lel-G LIC.NO.: In3ISJk Licensee: �ti O p � I V S6 ire Signature IC44/,v rsKi(�{, LTC.NO.: 364nIo G (Ifapplicabl enter "exempt"in the license number line) �,P//Bus.Tel.No.• .5 00 t-f 3?-;c(ry 1 Address: 7I 1.-DINER. CovNty ! OPcp MAI4WLM1ICt) T zt9`b AltTeLNo.: *Per M.O•L.c. 147,a.57-61,security work requires Department o¢Publio 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)0 owner 0 owner's agent. Owner/Agent• I Signature Telephone No. PE.diMITFEE:• $' 23131- The Commonwealth of Massachusetts ,. �.ryry�,,yy,,[[,, Department• of industrial Accidents ,. 4'" x4,;' f Office of Investigations 600 Washington Street t Boston,MA 02111 i��-(4/ r www.ynrassgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Harwich Port Heating &Cooling LLC • Address: 461 Lower County Road City/State/Zip: Harwich Port MA 02646 Phone#: 508-432-3959 Are you an employer?Check the appropriate box: Type of project(required): 1.1 I am a employer with 75 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub contractors 6. 2 New construction ' 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have 8, 0 Demolition • working for me in any capacity. employees and have workers' $ - ' 9: 2 Building addition [No workers' comp.insurance comp.insurance' 10.12Electrical repairs or additions required.] 5. 0 We are a corporation and itsP 3.0 I am a homeowner doing all work officers have exercised their 11.12 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no employees.[No workers' 13.12 Other HVAC • comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AmGuard Insurance Company Policy#or Self-ins.Lic.ik HAWC815956 Expiration Date: /1"/0//j266/2�0118 Job Site Address: $ ! �.d'I/' tit t' City/State/Zip: ( tt�/Y W /47161 Attach a copy of the workers' compensation policy declaration page(showing the policy n>�ber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. _ _ _ I do hereby certify under thea and pena les ofperjury that the information providee / v d/aboove is e and correct Signature: Date: V1�/ 1 III Phone#: 508-432-3959 111 Oficial 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#: . e. HARWICH PORT 9/10/2018 • HEATING AND COOLING HEATING I COOLING*ELECTRICAL•PWMBING ELECTRICAL PROPOSAL 0000023137 BILL TO: LOCATION: Susan Mill Susan Mill 87 Eileen Street 87 Eileen Street Yarmouth Port MA 02675 Yarmouth Port MA 02675 CUST M 0015518 SALES REP AndyL DESCRIPTION AMOUNT Job Description: Miscellaneous electrical work. Scope of Work: -Replace(5) basement keyless fixtures with (5)two foot LED wraps and re-wire so that all fixtures are controlled by switch. -Wire and install(1)20 amp outlet with dedicated circuit for sauna. -Wire and install(3)GFCI protected outlets on 20 amp circuit at discussed locations. -Replace existing duplex receptacle in basement with a double duplex in the same location. -Replace(2)existing flood lights with motion detectors on the side of garage with new LED flood light with motion sensors. -Town electrical permit fee with inspection. TOTAL _ Payment to be made as follows: 30%due with signed proposal,40%due upon substaintial completion of the"rough",and remaining 30%due upon completion. Note:On small projects we may,at our sole discretion,bill the entire remaining balance(after deposit)upon completion. Material is guaranteed to be as specified.Work to be completed in a professional manner according to standard practices.Alteration/deviation from the above scope will be executed only upon written change order and will be an additional charge.All agreements contingent upon delays beyond our control. Customer agrees to pay all costs of collection, Including attorney's fees.This proposal may be withdrawn if not accepted within 30 days. Acceptance Signature: Date: We also offer Duct Cleaning, Sewer/Drain Cleaning, Emergency Services, Maintenance, Video Inspection &Location Services! 461 LOWER COUNTY ROAD-HARWICH PORT MA 02646-TEL.(508) 432-3959-FAx(508) 432-6075