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Home My WebLink AboutBLDE-18-005124 '.) Commonwealth of Official Use Only , fLAM Massachusetts Permit No. BLDE-18-005124 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.l/071 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:3/19/2018 City or Town of: YARMOUTH - To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perlorm the electrical work described below. 2 Location(Street&Number) 26 MEDINAH DR <0 8 3Cj 2- Owner or Tenant REIMER JAMES T Telephone No. Owner's Address REIMER DIANE M,26 MEDINAH DR,YARMOUTH PORT, MA 02675-1634 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 furnace 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 ToVal Transformers KVA No.of Luminaire Outlets No.of Hot TubsGenerators KVA No.of Luminaires Swimming Pool Above 0 In- 1:1No.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 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 Ileating Appliances KW Security Systems:* No,of Devices or Eauivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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: Robert E Bowdoin Licensee: Robert E Bowdoin Signature LIC.NO.: 51981 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:502 PITCHERS WAY,HYANNIS MA 026012582 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 Telephone No. PERMIT FEE:$50.00 II 317211 � q /'l - e lb/13011a Vt ..�. &matoametta a/rt/aeeaehucwlfa Off -trial Use DS - n YA° ccyy�� c7 {{7� Permit No. eip — S .Uepari?meal of Jiro aiming . %IP icy and Fee Checked ' • BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/O?) peaveblaat:) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK A11�h to be performed in Massachusetts Electrical code /sz,yMR 2.00 • (PLEASE PRINT IN INK OR7 PfEALLINF TION) Date: - `f 1 1S City or Town of: yOMwt.✓ To the Inspector o limes: By this application the imdersigned esce . .'s or er intention to . it. ,, the electrical work described below. Location(Street&Ntuber) l b ' 0 k& Th r - Owner or Tenant eQ "Mr lb I'&.� Telephone No. Owner's Address ' 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❑ Undgrd❑ . No.of Meters New Servlee , Amps / Volts , Overhead❑ . Undgrd❑ - •No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: f••-V•J'n.\G<- S\ , Completion ofthefolowinttabte may be waived by the Inspector of fires �aF -No.of Total UiNo.of Recessed Luminaires • No.of CeiLSnsp.(Paddle)Fans Transformer ICVA CI No.of Laminalre Outlets No.of Hot Tubs Generators KVA Above in- tvo orumergencyLrgating No.of f nntinalrea - Swimming Pool t° 0 ted. 0 Battery inter .' No.of Receptacle Outlets No.of OB Burner. FIRE ALARMS No.of Zones ,... , -z. - Burners No.of Detection and . . :.. No.of Switches • . - • .-, No.of Gas Bners .. ., . -•... Initiating Devices' ' - I U No.of Ranges ' " No.of Alr Cond. ' Too ` No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposer Totals: Detection/AieDeviees - .- . No.of Dishwasber Space/Area Heating KW Local❑Cyyonnection 0 Other No.of Dryer . ` Heating Appilanees icW Na f Devic�ei or Equivalent No.of Water • No.of No.of Data Wiring: • Heater IRV . Signs ' .. - _Ballasts. - - . - No.of Devices or Equivalent telecommunications Whining: • No.Hydromassage Bathtubs No.of Motor Total HP Na of Devices or Equivalent O 1 PIER: , . ..Attach additional derail ifdesireat arm required by the hrspeetorof W . Wank to StartVaof Electncal Wodc 00`UO (When required by m nicipal policy.)' • - . •-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 0. BOND 0 OTHER 0 (Specify:) - ---I ccrifos ander the pains and penalties of perjury,that the Information on this application is tine and complete. . . FIRM N- '4 : // LIG i exNO.: LL • Licenser: L nun1t% LIC.N0. 1 5g\L . ,•,_.. �L Signature (clinic: i Uce-I 3 1 .l Bus.TeLNo.• ,% AIL TeL No.: / /f C�� S �� +peril Address: c. 147,s.57-61,securit;wmtk r�Department of Public Safety"5"License: Lie.No. -, OWNER'S INSURANCE WAIVER: I am awar4 that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,f hereby waive this requiremq%L I am the(check one)0 owner ❑owner's agent. Owner/AgentPERMIT FEE:$ ot_.._..,.. Telephone No. ._..__;, _ .._— r • L .. i1 . The Commonwealth of Massachusetts • P =. • I._: r= t Department oflndustrialAccidents t. of= ' .1 Congress Street,Suite 100 4'1= e Boston,MA 02114-2017 ';..z,r�° www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesibly Name(Businessiongaaiaation/individual): Jt1 Ic €t1 V-'UL`4"\- Address: a 'N1/4- e tAhii City/State/Zip: 1A'`f N\S Phone#: —2 79:3 4.46-01(07 An you as employer?Cheek the appropriate bo:: Type of project(required): 1.0I am a employer with employers(full and/or part-time).* Wil' 7. ❑New construction 2.21.1 asole te• partnership and have no employee,,working for me in 8.-0 Remodeling any [No waters'comp.insurance required] 3. I am a homeowner doingall wort gyp.• R4��I 9. ❑Demolition myself[No insurance t • 4.01 am a homeowner and will be hiring contractors to conduct an work on my property. I will10 D Building addition , ensue that all awohaaons either ban workers'catmensation insurance or me sole 11.0 Electrical repairs or additions proprietors with no employees l2 m 5.D1era ageneral eormartorandIIamhimdtienub• listed on ams D Plumbing or additions These sab-a rs have employees and have wrs'comp.insunmcer 13.0 Roof repairs ... 6.0 We are a c iiand n iromcershave esacisedtheir rightof per MQ. 14.DOther employees.[No workers'comp insurance required.] 'Any applicmttiat checks bon I must also fill out the section below showing their waiters'compensation policy information. ?Homeowners who submit this affidavit indicating they ane doing all work and limn hire outside contractors must submit a new affidavit indicating such. ?Contractors that check this box must attached an additional sleet shoving the name of the nab-ccadtauna and state whether ornot those=ids lave employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer Malls providing workes'compensation tnsarancefor my employees. Below it the policy and job site information. Tee, kr Insurance Company Name: Policy#or Self-ins.Lic.#:\tc `)W i\ 61Expiration Date:\/ ''i01 /c / /1 1 4 ' V Job Site Address: \ City/State/Zip: 7 arenikA`--. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 152,¢25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in dee form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tr.:_____Ind penalties ofperrjary that the information provideeddf it truQeand correct $i>mafure: —� y Date: J ` 1 O Phone#: My— .>b�0 1 101 e Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Pennit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other \ .