The URL can be used to link to this page

Home My WebLink AboutBlde-21-006422 �. Commonwealth of Official Use Only }E Massachusetts Permit No. BLDE-21-006422 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:5/6/2021 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) 396 ROUTE 28 Owner or Tenant LOVELETTE KATHLEEN TR Telephone No. Owner's Address 396 MAIN ST REALTY TRUST, 119 HIGGINS CROWELL ROAD,WEST YARMOUTH, MA 02673 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: Install generator 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 rnd. 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 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: Kung-Po Tang Licensee: Kung-Po Tang Signature LIC.NO.: 21928 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:518 COTUIT RD, MASHPEE MA 026492351 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: $100.00 le, 64, 6,qs Y/,„ )S1( 1121 ee-S1 ,51249-1 emirnoruoea a`Maseacizusett� Official Use Only )` f1 c� / Permit No. 2-1— (44 Z'Z • department of firs Services I( �`' Occupancy and Fee Checked ',, ��,,..' 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 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO% TION) Date: S— q- 2. ( City or Town of: '4-v m c' -'t' To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform` the electricalwork described below. Location(Street do Number) '3,6 /v` c >� $- I l,.{L �-r rn,, i '� Owner or Tenant (_b✓`e 4?f L n 5 vi.r , , -Q Telephone No. to d k -3 61t-2 S 3 Owner's Address Is this permit in conjunct on with a building permit? Yes ❑ No ® (Check Appropriate Box) Purpose of Building ` .j Yrl irti c,V0. l Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: G�inkr ..Za\,- Completion of the followingtable may be waived by the Inspector of Wires. No. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tranf Tro KVAsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators I KVA 2 Z No.of Luminaires SwimmingPool Above L. 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 Tons 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 0 Municipal ❑ Connection Otile, No.of Dryers Heating Appliances KW Security Systems:* 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 Wirin 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.) —7 Work to Start: C - Z / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: jdliless 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 g 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: J�-- LIC.NO.:-2 (5 23 /} Licensee: — I, Signature s LIC.NO.: S 2 ?8 alapplicabl xe tirLi' 'in/�e lice e nub'li e.) Bus.Tel.No.: lr/!t' 7J-�Lr Address: / yL(f G S 17 ttil P c' 769 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department o 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. I PERMIT FEE:$ The Commonwealth of Massachusetts Department ofIndus#r ial Accidents Office of Investigations -art 600 Washington Street . -� Boston,MA 02111 is t.. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Kung-Po Tang Address: 518 Cotuit Rd. City/State/Zip: Mashpee, MA 0 9 Phone#: -.6.86-750 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 2 4. I am a general contractor and I �p1 (y have hired the sub-contractors 6. New construction ees full and/or part-time).* 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. t 9.' Building addition required.] 5. We area corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' ' 13. °tiler 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 anew affidavit indicating such. Contractors that duedt 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 nub-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: Hartford Fire Ins.Co. Policy#or self-iris.tic.#:08WECAA7BJJ Expiration Date: 09/08/2021 Job Site Address: City/State/Zip: 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 certifp under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#; 781-686-7506 Official use only. Do not write in this oreu,to be com,pletedby city or town of cif City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cltylfewu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1�