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Home My WebLink AboutBLDE-19-000841 ` Commonwealth of Official Use Only > E` Massachusetts Permit No. BLDE-19-000841 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:8/13/2018 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) 37 LEGEND DR Owner or Tenant FIELD CRAIG S Telephone No. Owner's Address FIELD SANDRA A,37 LEGEND DRIVE,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 ❑ 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: Install generator. 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 1 KVA No.of Luminaires Swimming Pool Ab0 In- o No.of Emergency Lighting grnove d. 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 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: I 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 Signs 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 f 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: RICH M MELVIN Licensee: Rich M Melvin Signature LIC.NO.: 21829 &applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIR,S YARMOUTH MA 026641207 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature �� // wwp�� (� Telephone No. PERMIT FEE:$50.00 // `, $ ,, &G h1 [bong litoqrauAt_ iser pled) eVrt tee X05 fa) eg(9- 1/2c/'s Commonwealth o/rr/assachuseifs Official Use Only I �=lrt Permit No. �7 e(9-toga ( r r. -M ` Permit oll ire �ervicee Occupancy and Fee Checked �; .,.- G . `, --" BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Co Qg C),527 CMR 12.00 (PLEASE PRINT IN INK OR IT?E ALL INFORMATION) Date: ((1) 41 City or Town of: UffN J f In To the Inspector of Wires: By this application the undersigned gives notice of hi other intentoto perform ills electrical work e cbed e ow. Location(Street&Number) 31! eyen,c r vt. L0vft 1 ]ttf nifh crbb Owner or Tenant (rat(A r Telephone No. 50;9 99132.2, Owner's Address J cctW14 as &leo ✓e- ..-- Is Is this permit in conjunction) `thabuilding permit? Yes ❑ No (Check Appropriate Box) Purpose of Building bw811 Vici 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 ' " I Location and Nature of Proposed Electrical Work: Gui era-01 I A S TU 111 Ti On amulet/on o the ollowin: table in. be waived b the Ins,ector o Wires. 0.0 ota No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators ICVA 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 No.of Switches No.of Gas Burners No.of DInitiaattingon and ng Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers HeatPum umber_ _Tons_ TRW ._ No.of Self-Contained P Totals: .L ... Detection/AlertigDevices Municipal 0 Connection ❑ No.of Dryers Heating Appliances KW Security Devices 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 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: 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 exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) M I certify,under IYJ the pains and penalties of perjury,that the information on this application is true and complete. FIRM NA C tt) OJ.SLOW • _ • e. a f. , - • LIC.NO.: 53'/ d' Licensee: ei LIC.NO.�/S2? U ter"-R(LQ /1t,2Lense number Signature 'I ( o (Ifappliwble,enta�lJ''"�ex�"amppt:" in the,((cerse line.) Bus.Tel.No:fi v8.3 9Y•'77 j Address: 9r /Lf d-OOP &teat 5Uu1*I ((flnioutt-1,vIIf O7- ' Alt Tel.No.: - c� °Per M.C.L.c. 147,s.57-61,security worlf requires Department of Public Safety"S"License: Lie.No. IO OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally v required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. 1] Owner/Agent PERMIT FEE: 5 Signature Telephone No. • MIA 1 ' l I/{. yVIIHI/VI/Iy44//// V arts 11,16•041611.1•MATAISIA t 1DDepartment of Industrial Accidents + -- . 1 _i i= ' Office of Investigations '' _i.11`_ 600 Washington Street Boston,MA 02111 \p,.,----00- plY www.mass.gov/dia • Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly Name(Business/Organization/Individual): E•F.Wins I ow kb... 6i L ata\-,+�, Ce.} InC. Address: Qeo dtv1 Catt,1Q. 0 City/State/Zip: So„kn 'cn'-':,,,(-t., t4Pc Phone#: 501,-' 99-117751 Are you an employer?Check the appropriate box: Type of project(required): I am 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.I 7. 9 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers'comp.insurance 5. 0 We are a corporation and its . required.] officers have exercised their 10.0 Electrical repairs or additions .❑ 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' 13.❑Other comp.insurance required.] .ny applicant that checks bilk#1 must also fill out the section below showing their workers'compensation policy information. -lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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. vii an employer,that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. //�� surance Company Name: t e'a-1 rL1/4•411e. /1 jr":0ftivn n Cts 1iy ,licy#or Self-ins.Lie.#: \13 a I A •- Expiration Date: {—[ - ail t9 b Site Address: 3 CridwyNon wee-1411 Akt-e/ C4e&M AA City/State/Zip: 004 67 7 ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a le 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 'up to$250.00 a da a ainst the violator. Be advised t•.t a copy of this statement may be forwarded to the Office of vestigations the DIA for insura. • overage veri a,on. to herebycertify un • e airs a Ypenalties o p-jury that the information provided above is true and correct. :natEin: _ Ur / . . Date: la I o101' lone ft: .9)%:354. 7 7 7$ 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#: