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Home My WebLink AboutBlde-19-000719 '` or ty‘ Commonwealth of Official Use Only 'E` Massachusetts Permit No. BLDE-19-000719 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:8/6/2018 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 be.w. (StreetNumber) c t 6 4 r.' ( )(i Location & 10 CONWAY DR - ( " Owner or Tenant SOUNDVIEW REALTY TRUST Telephone No. Owner's Address 1 YANKEE DR, SOUTH YARMOUTH, MA 02664 ' Is this permit in conjunction with a building permit? Yes 0 No 0 ( j / Purpose of Building Utility Authorization' ..F _ L/b Existing Service Amps Volts Overhead 0 Undgrd 0 o teeters' New Service Amps Volts Overhead 0 Undgrd 0 All' . •rs _8( Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: New residence �� Completion of the following y/6e4 • t l o ires. No.of Recessed Luminaires 24 No.of Ceil:Susp.(Paddle)Fans 4 No.of ��r'''� • tt Transformers No.of Luminaire Outlets No.of Hot Tubs Generators , No.of Luminaires SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 60 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 32 No.of Gas Burners 1 No.of Detection and Initiating Devices No.of Ranges 1 No.of Air Cond. 1 Total 3 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 1 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 Siens 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 0 OTHER ❑ (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 LIC.NO.: 25035 (If applicable,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"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:$180.00 ) Official Use Only �ma wnw o{ccm n[ / (� ! k 2sparknant o/ iar Jsrviced Permit No. 1� -1 * Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i�` 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: $-' ` /� City or Town of: /c41 a p r4 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) /D Co nvitI / , o �BerT:..r} Owner or Tenant vita In ,Fh x i/'4. Telephone No. Owner's Address �3 b4.,-/e d , ,& s44,7o74- ' Z- Is this permit in conjunction with a building permit? Yes ❑�-- No 0 (Check Appropriate Box) %I Purpose of Building Si j Jac J �, , / Utility Authorization No. a`.9 i /S Existing Service Amps / ----faits Overhead❑ Undgrd❑ No.of Meters 4ENew Service ,7,0 Amps 4/0. /2 "Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity o Location and Nature of Proposed Work: ,',,e-.A R. e. _ /',.ro S Y.....— VI Completion of the followinktable my be waived by the hyvector of Wires. ‘ri Total No.of Recessed Luminaires No.of Cell. (Paddle)Fans i To.of 'Seap Transformers KVA t. C.) No.of Luminaire Outlets No.of Hot Tubs Generators KVA n Above In- No.of Emergency Lighting <k No.of Luminaires Swimming Pool mod, ❑ gaud. ❑ Battery Units No.of Receptacle Outlets 40 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches , No.of Gas Burners +No.Io Detection and >I Initiating Devices 1 No.of Ranges / No.of Air Cond. Ton` No.of Alerting Devices No.of Waste Disposers HeaTT Number Tots ._._ ._.......___.. Det of Self-Contained otals: ection/Ale No.of Dishwashers / Space/Area Heating KW Local 0 Conn 0 Other No.of Dryers Heating Appliances ' SeaN ofievkes or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or " .Bivalent b No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications ' i i : y e No.of Devices or Eq nt b p OTHER: N. 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: /7 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 [r BOND ❑ OTHER 0 (Specify:) certify,wider the pains and penalties of pe►jury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee:ft, s*t' � �` .i Signature e LIC.NO.:C':Q•5-0 'J (If applicable,enter"exempt in t e license number line.) Bus.TeL No.:77f%2/ e2 -1— 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 ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts ._`it. / Department of Industrial Accidents " Wit 1 Congress Street, Suite 100 _ 41— Boston, MA 02114-2017 two, Workers' www.mass.gov/dia Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organizafinn/Individual): Address: City/State/Zip:/ p•ski s ,/� A- Phone#: ,-Z/ ) _23 , Are you an employer?Cheek the appropriate box: Type of project(required): 1.01 am a employer with / employees(full and/or part-time).* 7. ew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myselfrequired.]t 9. ❑Demolition [No workers'comp.insurance 4.0 I am a homeowner and will be hiring contractors to conduct all work on mY P PAY•ro 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.p Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption 14.Q Other gh pti per MGL c. 152,§I(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 for my employee& Below is the policy and job site information. Insurance Company Name: ri,r`7 �'y r o 500' 2c /7 Policy#or Self-ins.Lic.#: 'a G 66 L Expiration Date: D� Job Site Address: /0 t' ii &.•4 p'al3r► City/State/Zip , o kJ Attach a copy of the workers'comp cation 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 p ' and n ' f perjury that the information provided above is true and correct Si ature: _ Date: Phone#: Z .f C .2 3 S 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#: