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Home My WebLink AboutBLDE-22-002660 ,of Commonwealth of Official Use OnlY A,. 6:A1 Massachusetts Permit No. BLDE-22-002660 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'11/9/2021 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) 4 EBB RD Owner or Tenant Michelle Szado Telephone No. Owner's Address 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 ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring of addition(rear of garage)&possible panel replacement. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 1 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 8 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. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons 1 KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs 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: Paul J Bacher Licensee: Paul J Bacher Signature LIC.NO.: 38253 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:88 FIVE CORNERS RD,CENTERVILLE MA 026323126 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:$75.00 (a_tycat tt i.4-A a - i,nofr - Z8(Z?i R E C E I V E D .. I ..' _. Commonw.a fL a{/1/aaeac Official Use Only 1 ,,1 2021 �7� Z—c— ' C 1 L .`". lrt i� `.� im�' Permit No. 3 � a�arfinr�a j rcte BU I_!1 1 t__ •ARTMENT Occupancy and Fee Checked �'BY ---V --- :s . : . OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accardanc a with the Massachusetts Electrical Code(MEC), 27 12.00 (PLEASE PRINT IN INK OR T YPE ALL INF RMATION) Date: J / I i City or Town of: To the Inspe or o Wires: By this application the undersgnvex no of h�r her in� 'on to perform,di�electrical r�l'1 j1c 4:.«� ow. Location(Street&Number) \ 1 �,r i t Owner or Tenant M Lr 2 v Telephone No. 4 Owner's Address St--li►-� C e, Is this permit in conju with building permit? Yes EY No 0 (Check Appropriate Box) 1 Purpose of Building 1 -e�I art,G-€ Ur Authorization No. I Existing Service (DU Amps (20 I ago Volts Overhead El No.of Meters S! / ___Q 1 New Service NA Amps / Volts Overhead❑ Undgrd❑ No.of Meters -- Number of Feeders and Ampacity • Location pad Nature o Promoted Eiertrical Work: Ci-- Completion of thejoAdwingtabk be waived by I of Wires. )` No.of otal 'z, No.of Recessed Luminaires Li No.of Cei.-Susp.(Paddle)Fans 1 Transformers KVA 1"-:',1 No.of Luminaire Outlets 1 No.of Hot Tubs Generators KVA f°; No.of Luminaires SwimmingPool Above ❑ In- ❑ a o Emergency Lighting grad. grad, Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Barmen No.of Detection and initiating Devices No.of Ranges No.of Air Cond. T otal No.of Alerting Devices ontained I No.of Waste Disposers HeatTo Number_To>isJ ' Det of ectio�Alertis< Devices _ (K No.of Dishwashers Space/Area Heating KW Local❑ Coanecti in ❑ Other No.of Dryers Hadng Appliances Kw SecuJIty 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 No.of Devicesor Equivalent OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of "cal Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE GE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides f of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such covptage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Mg BOND 0 OTHER 0 (Specify:) I cerdfy,under the pains and pena offperjury,that the information on this application is true and complete. FIRM NAME: , , LIC.NO.: Licensee: pet v �L Signature ��,�y, V �� 4t, %,,,AN LIC.NO.: ;Ea (If applicable,enter'exempt"in the license number line.) 1 Bus.TeL No.• .rs ."'T+�t 'M q i'ld ) Address: Alt.Tel.No.: :I' *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: lam 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts E_,511,_ 1 Department of Industrial Accidents . —TT a 1 Congress Street,Suite 100 Ccj=. y Boston,MA 02114-2017 y'.: —ems www mass gov/dia .. Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): RAJ ( 13 r;(. key- .Address: 35- (cApa,5 +p i j , k)oit le)'l r`ris A6I e MA 0 d 66 City/State/Zip: Phone#: ( bj)36I- 11 5 Xi Are you as employer?Cheek the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time)..* 7. 0 New construction 2.'I atn a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.I'Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor haveI have hired the listed on the attached sheet 13. Roof airs These sub-contractors employees and have workers'comp.insurance.t ❑ 6.0 We are a corporation and its officers have exercised their right of exemption per MG.c. 14.Et Other 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Arty 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. 3Contractors 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: LI E.6.1. V`LI City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby 7 under a pains , - . ,-nalties of perjury that the information provided above is true and correct Signature: i 4 �4°P Date: 1 f __11.j_l Phone#: 6-0 9.34/ se/5, 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#: