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Home My WebLink AboutBLDE-22-003147 Commonwealth of Official Use Only �` /1\ Massachusetts Permit No. BLDE-22-003147 B ARD 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:12/2/2021 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) 19 AUTUMN DR Owner or Tenant COLLINS JAMES E Telephone No. Owner's Address COLLINS JANE M, 19 AUTUMN DR, SOUTH YARMOUTH, MA 02664 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 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: Replace damaged generator&transfer switch. 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 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 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 ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water K, No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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 ❑ 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: JOSEPH P ROSE Licensee: Joseph P Rose Signature LIC.NO.: 21335 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:25 Beverly Rd,West Yarmouth MA 026733559 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 my 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 " & e�ikal�n, ,c�.i //,,Official Use , Per L t No. �i71 Zk7 - : iOccupancy and Fee Checked ` ,. Y BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be perform in accordance with the Massachusetts Electrical Coax ,sn CM(12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: lap m 1 City or Town of: VW.en(�v.YV\ To the nspe or of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 11 -NU U'1 InD r. , - A r Iut\ Owner or Tenant L Gyp Irv; c. U 1 1 I n 3 Telephone No. T U 1).;-?3 \11 Owner's Address M b this permit in conjunction with a permit? Yes 0 No 0 (Cheek Appropriate Box) ,o Purpose of Building Utility Authorization No. 1 Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Nov Service ,Ape / Volts Overhead❑ Undgrd 0 No.of Meters --4_ Number of Feeders and Aega city Location old Nature of Proposed Electrical Wort ACPI e,e r It-I kk.r i <-n 4r-6 - - eo �{ t t ` ✓ Completion of to followinfLtable be waived by the hussecitar of Wirt vt o.of Total ll) No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans Trannsfermer�s KVA No.of Luminai a Outlets No.of Hot Tubs Generators 1(4 agr KVA motif '/ nail - No.of Leminid rss Swimming Pool Above e ❑ Imo, ❑ Barry U� No.of Receptacle le Outlets No.of O11 Burners FIRE ALARMS No.of Zones , Z- Detection and No.of Switches No.of Gas Burners �o.Init i Devices It No.of Ranges No.of Air Coed. Teas otal No.of Alerting Devices No.of Waste Dhspoees "I ---Pump lrfimber Tons KW— De*ie ob Na.of Dishwashers Space/Area Heating KW Local❑ CD 0 Other No.of Dryers Heating APP KW SecNo.ofSl�or Equivalent No.of W , No.of No. Heaters Ballasts No. Devices or t Serra "Teleconnanaleadons a � � No.Hydros Bathtubs No.of Motors Total HP of Devices or OTHER: Attach additional detail tidesired 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 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE/al ❑ OTHER 0 (Specify:) I�f,s drepains of perjury,tat the bnybr�tos on this appliardws is One and c Nm complete. FIRM NAME: £c 4- e L a/33c A Licensee: signatureifr r 0!,✓e"- LIC.NO.: )03-31 8 (/f appl' enter"exempt"in the l menber tr+�) Bus.Tel.No.: Address k-Vale14-5 _ 11"'• y tetra u Alt.Ter.No.: •Per M.G.L c. 1s.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 0 owner's agent. Owner/Agent Telephone No. I PERMIT FEE:$ The Commonwealth Of Massachusetts • Department of Industrial Accidents 1mi 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): „SO S c. � g C. Address: p�fj L.��/� � P, 4 U.) ` ham r� �^ Cb,C0-1 3 City/State/Zip: Phone#: -] 3 5 3 7 1, Are you as employer?Cheek the appropriate box: Type of project(reed): 1.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction 214I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling may capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work9. ❑Demolition ❑ myself[No workers'camp.insurance required.]t 4. I am a homeowner and will behiring 10 []Building addition ' ❑ contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractorand I have hired the sub-contractors listed on the attached sheet. 13. Roof These sub-contractors have repairs emP oyegt;and have workers'comp.insurance.: ❑ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,$1(4),and we have no employees.[No workers'cramp.insurance required.] *Airy applicant that checks box pI must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing ail 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: )p 1 P\LA-1.0 Wl N '. City/State/Zip: �ll,r fry .• Attach a copy of thu workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure co4rage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imp sonment,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 ertify under the pains{ and penalties of perjury that the information provided above is true and correct Signature: p V<�E,vy� Date: ) A ,2 UR Ph J Phone#: Official use only. Do not write in this area,to be completed by city or town offeiaat 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#: