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Home My WebLink AboutBlde-22-001848 "` Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-001848 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:10/1/2021 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) 7 RITA AVE Owner or Tenant MANN PHILIP G Telephone No. Owner's Address MANN JUDITH E, 7 RITA AVE,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: Remodel kitchen&2 bathrooms. 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 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. Ton l 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent 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 ❑ 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: Douglas S Velie Licensee: Douglas S Velie Signature LIC.NO.: 21245 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:6 SANDY MEADOW WAY, EASTHAM MA 026426104 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 Low/ i of c/ 1 a- RECEIVED OCT 012021 iZi.,_,_ _N __ .__._. �}�J�f tudsito Official U��Ye, DING DEPARTM ° � "./'"'pse°c l..`r ,• _1 — P°' 4 Permit No. 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 INFORMATION)�:,3 Cityor Town of: 1 O.)i Date: / 0 ( Zo�I To the Inspect r ojWires: `�� By this application the undersigned gi es notice of his or her intention to perform the electrical work described below. .4 Location(Street&Number) -7 fa 11/X A VI e 1_Owner or Tenant js Telephone No. Owner's Address trA MI e Is this permit in conjunc on with a building permit? Yes d No El (Check Appropriate Box) i Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd El No.of Meters _ID 7 New Service Amps / Volts Overhead❑ Undgrd El No.of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Work: V(it (46-N i Z. 6 i1t g r r o p0... Completion of the followingtable may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of CeIL (Paddle)Fans No.ofKVA �°sP• Transformers KVA S KVA 1 No.of Luminaire Outlets No.of Hot Tubs Generators 47 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.Initlatingon Dete and In Devices 1 ' No.of Ranges No.of Air Cond. Ton No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste DisposersTotals: Detection/Alerting,Devices No.of Dishwashers Space/Area Heating KW Local 0 Connectton 0 Other No.of Dryers Heating Appliances KW Securityy stems:* Noof Devices or Equivalent No.of Water , No.of No.of Data Wiring: IC Heaters Signs Ballasts No.of Devices or Equivaglent No.Hydromassage Bathtubs No.of Motors Total HP Tel N 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: 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 cov7ige is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ug BOND 0 OTHER ❑ (Specify:) I certify,under theandp pens of perjury,that the ortrwtion this application is true and complete. FIRM N F-0. A/ T iC At- roe LIC.NO.: Z/2 c Licensee: 1 00 t-pc49 U Signature C LIC.NO.: 2- (Ifapplicable. ter empt"in the lic nse number line). , us.Tel.No.:j — 37 Address: e 16 n/1( ,ou- 'uvD� r Alt.TeL No.. *Per M.G.L.c. 147,s.57-61, curity work requires ent 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 Signature Telephone No. PERMIT FEE:$ 7. • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 4,9 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Please Print Legibly �, Name (Business/Organization/Individual): t�J `.i "i '/�_ C'!�(— 4411* 1)e.6 Address: (t2 , t,1 Q' (45e90/0 00k1 City/State/Zip: Ni A- 02642, Phone#: Z64 /31,1 Are you an employer?Check the appropriate box: Type of project(required): 1.16 am a employer with `T employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself. t 9. Demolition❑ ys [No workers'comp.insurance required.] 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.El Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§I(4),and we have no employees.[No workers'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. rr Insurance Company Name: - 7 Policy#or Self-ins.Lic.#: Expiration Date: 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 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 cent,un er ti e pain and enal o erjury that the information provided above is true and correct. Signature: 1' Date: 1 d t 12.o Z( Phone#: 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#: