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Home My WebLink AboutBLDE-19-001722 "'' Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-001722 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked fRev.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:9/21/2018 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) 36 CHANNEL POINT DR _ Owner or Tenant PETERS R NORMAN TR Telephone No. Owner's Address THE CHANNEL POINT NOM TRUST,8 OLD LANTERN CIR,PAXTON,MA 01612 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install two receptacles,4 recessed lights,&1 paddle fan. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 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. grnd. Battery Units No.of Receptacle Outlets 2 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 2 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 I 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 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 if desired,or as required by the Inspector of Wire; 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: MICHAEL J MAGUIRE Licensee: Michael J Maguire Signature _ LW.NO.: 25035 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:148 AUDREYS LN, MARSTONS MLS MA 026481631 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 LI/fa- 9/isli e Para( to/tag, k-t, « '�8(c'5 /t�� Massachusetts&, essurionweat(k o/tr/assachusett Officiall Use Only �7 Permit No. �9 — ( 1 L`� 1 i:Itt apeaewai o/.}In&nked illS) -1NI Occupancy and Fee Checked t1�IN 'a' BOARD OF FIRE PREVENTION REGULATIONS v.1/0 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MW).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9'— 2 / — /S City or Town of: k/-rr D v TA 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) 2 6 C/i ,—ti h „ / fie r:, ,— Owner or Tenant A/,,r in o h fie_re s Telephone No. Owner's Address Is this permit In conjunction with a building permit? Yes f7h No 0 (Check Appropriate Box) Purpose of Building siepir n•. Utility Authorization No. Existing Service .70,, Amps /So / .Z •Volts Overhead 0 Undgrd Q- 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 .12,./6/Work: .12,./6/ .o a eTV�T . y /9,6---1 � •• /� l/ re AC...,..-c. EgrUij O*•— ..0.4....././4 " " Completion of the followingfable may be waived by the Inspector of Wires. Total U) j No.of Recessed Luminaires No.of Cell.-Sm (Paddle)Fans No.of KVA P Trnsformen KVA Ai No.of Luminaire Outlets No.of Hot Tubs Generators KVA j No.of LuminairesSwimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd Battery Units . f No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones l { No.of Switches No.of Gas Burners No of Detection and `-'JZ Initiating Devices `� I U I No.of Ranges No.of Air Cond. Tom No.of Alerting Devices )) No.of Waste D1a xrs Beat Pump Number Tons 1KW No.of Self-Contained po Totals: Detection/Alerting Devices ,:c.,)r_._.._1i No.of Dishwasher Heating KW Local 0 Coeeecptliloa 0 Other Ili I l No.of Dryers HeatingAppliancesSpace/AreaHtinSecurity Systems:* No.of Devices or Equivalent `,x N 11 o.of Water Na of No.of Dab Wiring: la Heaters Signs Ballasts Na of Devices or Equivalent KW w c"/ !° o.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: V W 1Na of Devices or Equivalent z R: w Ct ' c" 1° Attach additional detail ttide:tied oras required by the Inspector of Wires. m timated Value of Electrical Work: (When required by municipal policy.) ork 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 Er BOND 0 OTHER 0 (Specify:) I certify,ander the pains and penalties of perjury,that the Information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: Gr/r �..e Signature 2L; LIC.NO.:625-1/40.7S'a- (I./applicable,enter"exempt"in th Kense number line.) ' - Bus.TeL No: Address: Alt TeL No.: *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)0 owner 0 owner's agent. Owner/AgentPERMIT FEE:4,j� SignatureturaTelephone No. The Commonwealth of Massachusetts = "/ Department oflndustrialAccidents asiasIN 1 Congress Suite tali! Boston, MA 021 100 14 2017 c.,�. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. • Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: - Type of project(required): 1.0 lam a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in - $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. t am a homeowner doingall work elf 9. ❑Demolition ❑ toys [No workers'comp.insurance required.]t • 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the subcontractors listed on the attached sheet 13.❑Roof repair These sub-contractors have employees and have workers'comp.insurance.; 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'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 a new 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 jor my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 c. 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 the 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 under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 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/Cown Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: