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Home My WebLink AboutBlde-19-002529 Commonwealth of Official Use Only i . ` t Massachusetts Permit No. BLDE-19-002529 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:10/29/2018 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) 24 SPINNING BROOK RD Owner or Tenant NAEHLE HENRY E(LIFE EST) Telephone No. Owner's Address NAEHLE REGINA M, 15 TIFFANY LN,ANDOVER, MA 01810-3316 Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropri g ox) Purpose of Building Utility Authorization No. / Existing Service Amps Volts Overhead ❑ Undgrd ❑ At ere New Service Amps Volts Overhead ❑ Undgrd ❑ sof s Number of Feeders and Ampacity 0 OPP' Location and Nature of Proposed Electrical Work: Install generatorOOCompletion of the,following table may be waived b, 'e In . „,0 es. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of v, Transformers ' No.of Luminaire Outlets No.of Hot Tubs Generators 1 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 ❑ 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: ANDREW M LEVESQUE Licensee: Andrew M Levesque Signature LIC.NO.: 17318 (If applicable,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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 c ? - 4 im, i( u T C-0 l/I fz U' 410 PL �P►�d o(rctJ r ' _ Commonwealth oil Va9eac�iuieits Official Use Only *_ R -2 2 a. ----Air—�!i Permit No. nl- Permit of gire�eruices E- Occupancy and Fee Checked �.==�=�=� p y "> .-�,/ 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 MR 12.00 (PLEASE PRINT IN INK OR ALL INFO Zt City or Town Inspectorof TI N) Date: I t of: 0 U l To the Wires: By this application the undersigned gives notice of his or her intention to perform�j the electrical work described below. Location(Street&Number) 9.i-{- g F 1 N N l N6 &ROV P. OMJriS Q v-ri4 yAr1OV1+ Owner or Tenant f.,J1 C uyie-r Hi Telephone No. Owner's Address Is this permit in conjunc 'on with a building permit? Yes El No rg (Check Appropriate Box) Purpose of Building 9(O NL' Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead El Undgrd❑ No.of Meters Number of Feeders and Ampacity r f/� I /' Location and Nature of Proposed Electrical Work: (A [ k.I N& V F t U/ I V ci ,b(/ -fV/ ._ .Completion of the followin&table may be waived by the Inspector of Wires. N r No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans T of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ tBattery Units a . 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 Tota No.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: _._ Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection _ Heating Appliances KW -Security Systems:*No.of Dryers 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 El ctrical Work: 1 V V V O (When required by municipal policy.) Work to Start: -.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 Ig BOND ❑ OTHER 0 (Specify:) y ,.,. • f I certify,under the pains and penalties of perjury,that the information on this application is true and completes FIRM NAME;4-66AV`` I FO KT �-i-�1 1 N(7.-I-coo Li i�r7 y� ,LIC.NO.: J(1114,6 Licensee: [ UV fi f/VgS�,N Signatureiko "v -0-7 LIC.NO.: _ry (If applicable filter "exempt"in the license number li �j r :. Bus:Tel.No.' . "1 Address:applicable, / L4iW - t T Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security wo�quires 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 Signature Telephone No. PERMIT FEE: $ — 2,3N-D 1 The Commonwealth of Massachusetts , '' Department of Industrial Accidents gc-4''' li'1., - f r-71' Office of Investigations ii �l �=' 600 Washington Street 4 = Boston, MA 02111 "ti" , 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: TypeTypeeneral contractor and I of project(required): 1.2I am a employer with 7fi 4. ❑ I am a g employees(full and/or part-time).* have hired the sub-contractors 6. �/(New construction 2.0 1 am a sole proprietor or partner- These on die attached sheet. 7. [ Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. [J Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.2 Electrical repairs or additions officers have exercised their 11.2 Plumbing repairs or additions 3.❑ I am a homeowner doing all work 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. tContractors 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.Lic.#: HAWC815956 Expiration Date: 10/26//20018 ,�.�j�Job Site Address: gt'f- 1 V1 VI r P rbro-ole- )Zi( City/State/Zip: �' W V/Qvi' 1 Y l IV14 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 and pen es of perjury that the information provided above is true and correct Signature: Date: io/ O pg Phone#: 508-432-3959 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 TOWN OF YARMOUTH • 9y BUILDING DEPARTMENT oN. -y 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1263 Fax 508-398-0836 bl �'oAoo..icob d 'J G" K. Elliott, Inspector of Wires kelliott(a,varmouth.ma.us April 29,2019 Andrew Levesque Harwich Port Heating& Cooling 461 Lower County Road Harwich Port, MA 02646-1831 Location: 24 Spinning Brook Road, South Yarmouth Permit Number: BLDE-19-002529 Dear Andy, The above noted location inspection failed to pass for the reason(s) listed. Massachusetts Electrical Code 527 CMR 12.00 (Rule # 10) Conduit to be uncovered for inspection. 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