The URL can be used to link to this page

Home My WebLink AboutBlde-19-000908 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-000908 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:8/15/2018 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 electncal work described below. Location(Street&Number) 14 TROPHY LN Owner or Tenant HUNTER JUDITH A TR Telephone No. Owner's Address J A&Y HUNTER TRUST, 14 TROPHY LN,YARMOUTH PORT,MA 02675 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: Air cond.system. 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 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.of Detection and Initiatine_Devices No.of Ranges No.of Air Cond. 1 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 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 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 (If 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 Telephone No. PERMIT FEE:$50.00 64 f/74%8 ' IN71 _ C,ommonuiealth o�Maddachctdettd Official Use Un� ?GI:3t, t c c7 Permit No. C�`j et= hepartment o�.�`ire Serviced Occupancy and Fee Checked r ° --_{- BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/071 ° „, (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(7527200C) (PLEASE PRTK OR TYPEALL INFORMATION) Date: 11 City or Town of: 7 airv(a j i-k To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perf the electrical work/ described below.v\oD. 6 --� Location(Street&Numbe ) V Lone afir c T�'11 Of QtS Owner or Tenant Telephone No. �3 G a 1 v. 2- Owner's Address S OtPa4 _� Is this permit in conjunction with a building permit? Yes n No !/ (Check Appropriate Box) Purpose of Building `J(,f t[I(VI Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd n No.of Meters Number of Feeders and Ampacity r Locat. n and Nature of Proposed Electrical Work: �n5 (n 1 new ,i 5 1/i S 4014 � f Co' rrt(f, Completion of the following table may be waived by the Inspector o 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 Above In- No.ofEmergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units __ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ofand No.of Switches No.of Gas Burners No.Initiating Detectionon Devices otallo.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals:I l I Detection/Alerting Devices OtherNo.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection No.of Dryers Heating Appliances KW Security ystems:* Y 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.Ilydromassage 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 , :p,<::), undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. (6 „....O CHECK ONE: INSURANCE VI BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the informationi on this application is true and complete. FIRM NA : 11))✓LOW �._l�'l'tI�t1ULv d' kip" niz . LIC.NO.: �3a2`d'l(i ''. Licensee:( jC4- t2 D figeW (& Signature J �� LIC.NO.:01 S/`I?� ��°(� (If applicable,entq "ex�em,ptom�"in the license number line.) i Bus.Tel.No.:5G8.3 9y•7118- l7'� Address: `7} At/•1'Ii,(/'i( Gtt 50t#1 1i9'Q/11t?LL1 t 1 A ' 0 .4 Alt.Tel.No.• --''4 *Per M.C.L.c. 147,s.57-61,security worlf 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)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 4 DZ:\ A Y6 . @O6 rvb 1 66J LY Y3 666606 Vil I1J6p6 ..D6.6CJ ass 6 YiVO60OLVDepartment of Industrial Accidents ro i11�. Office of Investigations 600 Washington Street '°�� Boston,MA 02111 %6" d www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers j plicant Information Please Print Legibly fame(Business/Organization/Individual): E.C.w,,-ipw Cloomol L 0ta\- cm) I✓1f.. .ddress: (4v t tv) C't Q_ :ity/State/Zip: SoAiiN 'fcr -ic>)-t., t-tik Phone#: '50$- 394-VP7 re you an employer?Check the appropriate box: Type of project(required): I am a employer with '70 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet.t 7•_ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.0 Other iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 'm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. surance Company Name: p rt-o e-kviue-A A A CP_ Ctswyt-vvi Ilicy#or Self-ins.Lice.^#: I$oZ I A Expiration Date: (—I — aOI9 b Site Address:a3 Mr.,v-e0. 14-11 A,t eI Cher IA)11 City/State/Zip: Da L4 6 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. Re advised- t a copy of this statement may be forwarded to the 6ffice of vestigations the DIA for insura overage veri a on. to hereby certify un e e ains a penalties o p jury that the information provided above is true and correct. gnattirei Date: (al3i1aol7 lone#: ct 314. 7 77g Official use only. Do not write in this area,to be completed by cihy 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#: I 1