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Home My WebLink AboutBLDE-19-002433 0Commonwealth of Official Use Only a 4 Massachusetts Permit No. BLDE-19-002433 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:10/24/2018 /� City or Town of: YARMOUTH To the Inspector of Wi ers: -YL L /2Is By this application the undersigned gives notice of his or her intention to pertoms the electrical work described be � ' �' ��85'S �- Location(Street&Number) 95 OLD MAIN ST Jit l Owner or Tenant TRAUB JEFFREY J Telephone No. Owner's Address TRAUB LORRAINE F,95 OLD MAIN ST,SOUTH YARMOUTH.MA 02664-6009 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. 2302985 Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. 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 I No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool 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 Initlatine 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 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 fdesired,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: ANDREW M LEVESQUE Licensee: Andrew M Levesque Signature LIC.NO.: 17318 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:461 LOWER COUNTY RD, HARWICH PORT MA 026461831 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) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 ,z H 2-/t s Ke- (Ivy Aar Pg *0t 10.2. 1( 1/tt AP- rho-ali 4-itAsG Ca ewet ✓N TO ux10/4-4Yov etc_k c/(( • , �•'..iA _ CommonweaAL a///laeeachu4elfs �Of]ficial Use Only Q t i t c� c7 Permit No. eel9 ` ail F7 t r Thep:rlmed or ire services Occupancy and Fee Checked W 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 MINK OR TYPE ALL INFORMATION) Date: j b /2 3 City or Town of: PARI Wi/1tf To the I pector of Wires: By this application the undersignedves notice of his or her intention to perform the electrical work`described below. Location(Street&Number) �• �t�JQ1.n �-1 N S l rtoefl S-61/11-1(S-61/11-1( 'f•�z{M -r mb Owner or Tenant DIA,N PA-fa- Telephone No. Owner's Address Is this permit in conjunction withiah'-G building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Ie 1/ niUtility Authorization No. 2.3n,..?......el�j �j • Existing Service JOT) Amps 170/240Volts Overhead•] Undgrd❑ No.of Meters I New Service ) Amps L7.0/ 2gwolts Overheaj Undgrd❑ No.of Meters —1-- Number Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work: (4)t iz t 'J or 5E12.VI G& Li p6 .Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires . No.of Ceil:Susp.(Paddle)Fans 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. nDetention and Initiating Devices • To No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tops KW 'No.of Self-Contained P Totals: Detection/Alerting Devices _ No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Giber Connection s:* No.of Dryers Heating Appliances KW �ecNo ofDevices por _ Equivalent No.of Water • KW . No.of No.of Data Wiring: '- • HeatersSigns 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 ifdesired or as required by the Inspector of Wires. Estimated Value ofElectri al Work: AOt) (When required by municipal policy.) Work to Start: I 0 ) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RAGE: 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 X BOND 0 OTHER 0 (Specify:) • I certify,under the pains and penalties of perjury,that the information a this application is true and complete. FIRM NAME:.(-66cjr(WICI-FfOKT 4 KflNl7tft2OLLN6/ G LIC.NO.: 36CMte6 Licensee: V-TZ•Y W 4)14 Signature x 0-0 -4411-4,--LIC.NO.: A fj ' (If applicable nter "exempt"to the license number iii (,mq Bus:Tel.No.. �� . i —Cr Address: I[d I t4W� i2 CA �dQ )t ! t T Alt.Tel.No.: 1 *Per M.G.L.c. 147,s.57-61,security work r&rvires 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: $ go — Signature • Telephone No. The Commonwealth ofMassachusetts Department oflndustrialAccidents - .." 1 : ('{ Office of Investigations Ms 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/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): 1.2 I am a employer with 75 4. 0 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. ❑Remodeling ship and have no employees These sub-contractors have `, '8,'❑Demolition working for me in any capacity. employees and have workers' 9. [2 Building addition [No workers' comp:insurance comp.insurance.: required.] 5. 0 We are a corporation and its 10.12 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.2 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' 13.2 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 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 for my employees. Below is the policy and job site information. Insurance Company Name: AmGuard Insurance Company Policy#or Self-ins.Lie..#: HA� 15► I- WC8159556 Expiration Date: 10/26/2018 10/26/2018 Job Site Address: q 5 0 w` / af n St��C.C/I City/State/Zip: v Attach a copy of the workers'compensation policy declaration page(showing the policy numbe .nd 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 the and pen ies of perjury that the information provided above iv true and correct, Signature: Date: � 0!.�f l 2 Phone#: 508-432-3059 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#: oF Yak - TOWN OF YARMOUTH .1c cBUILDING DEPARTMENT oH 1146 Route 28,South Yarmouth,MA 02664 � �.,.• 508-398-2231 ext. 1263 Fax 508-398-0836 • K. Elliott, Inspector of Wires kelliott@yarmouth.ma.us November 1,2018 Andrew Levesque Harwich Port Heating& Cooling 461 Lower County Road Harwich Port, MA 02646-1831 Location: Peter Dunbar, 95 Old Main Street, So.Yamouth Permit Number: BLDE-19-002433 Dear Andy; The above noted location inspection failed to pass for the reason(s) listed. Article 210-12(D) Branch circuit extensions require A.F.C.I. Article 110-26(D) Illumination Article 110-12 Execution of work (Remove or plug old conduits through foundation.) Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained, to the property, for the re-inspection. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth, Building Department K.Elliott, Inspector of Wires