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Home My WebLink AboutBlde-19-000398t Commonwealth of Official Use Only �E o. Massachusetts Pennit No. BLDE-19-000398 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:7/18/2018 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 electiical'work described below. Location(Street&Number) 231 WILLOW ST Owner or Tenant CTS FIDUCIARY LLC TR Telephone No. Owner's Address TWO THIRTY-ONE WILLOW ST RLTY TRUST,231 WILLOW ST,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 0 i ' . New Service Amps Volts Overhead 0 Undgrd 0 i.ofiiiiiii, 'riff, . Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace or add CCTV equipment. �� Completion of the following table may be wa' (.' I , • Wires. No.of Recessed Luminaires No.of Ceil: No.of Susp.(Paddle)Fans Transformers 0 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 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 Heating Appliances KW Security Systems:* 10 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 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: GENE A CORMIER Licensee: Gene A Cormier Signature LIC.NO.: 1592 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:9 MARGATE LN, SOUTH DENNIS MA 026602667 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$115.00 1 ConunonweaUL o`MaackMails Official Use Only u / cc�� cc77 Permit No. aq '� 39 6 =`e., 2 epartment o`. ire Servicee 71-111---rif Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.cc.u113/0a7n]cy 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 Fes.., (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: July 16, 2018 5 City or Town of: YARMOUTH To the Inspector of Wires: W By this application the undersigned gives notice of his or her intention to perform the electrical work described below. a Location(Street& Number)231 WILLOW STREET Owner or Tenant TURTLE ROCK LLC SHARON PARKINS Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ✓❑ No ❑ (Check Appropriate Box) Purpose of Building COMMERCIAL Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace& Add Motion Detector Cameras to Existing Syst PLEASE FAX PERMIT& PERMIT# BACK TO US AT; 508-398-5666 THANK YOU Completion of the followin&table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf 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 of No.of Switches No.of Gas Burners No. Initiatinnggon Dete and In Devices vi No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices g Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices '-a No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security s:* N f Devices or Equivalent 10 No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: No.H y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:$ 3620.00 (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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE El BOND ❑ OTHER ❑ (Specify:) LIJ I certify,under the pains and penalties of perjury,that the information on this application is true and complete. gFIRM NAME: Cape Cod Alarm Co., Inc. LIC.NO.: 1592C p Licensee: GENE CORMIER Signature /-t, ,,„L, LIC.NO.: (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508 398-6316 Address: 204 OLD TOWNHOUSE ROAD WEST YARMOUTH, MA 02673 Alt.Tel.No.:800 468-8300 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SS CO 000248 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: $ 115.00 Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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): CAPE COD ALARM CO., INC. Address: 204 OLD TOWNHOUSE ROAD City/State/Zip:WEST YARMOUTH, MA 02673 Phone #: (508) 398-6316 Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with 30 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction listed on the attached sheet. 7. ❑ Remodeling 2.CI I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.' required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ILO Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.12 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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:Associated Employers Ins., Co. Policy#or Self-ins. Lic.#: WCC-500-5006433-2017A Expiration Date: September 1, 2018 Job Site Address:231 WILLOW STREET City/State/Zip:YARMOUTHPORT Attach a copy of the workers' compensation policy declaration page(showing the policy number and 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 pains and penalties of perjury that the information provided above is true and correct. Signature: i1t-e -. ( f��u,�,r� Date: July 16, 2018 Phone#: (508) 398-6316 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#: