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Home My WebLink AboutBLDE-23-000170 or Commonwealth of Official Use Only 1Li' Massachusetts Permit No. BLDE-23-000170 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:7/12/2022 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) 23 CAPT WEILER RD Owner or Tenant RAFFERTY MICHAEL C CO-TRS Telephone No. Owner's Address RAFFERTY SHARON I_CO-TRS,21 PRINCESS PINE CIR,TAUNTON, MA 02780 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 bathroom fan/light 1st floor bath. 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 Initiatine 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 0 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 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: Licensee: Jarren Frade Signature LIC.NO.: 57653 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:20 Orchard Street, Berkley MA 02779 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) ❑ owner 0 owner's agent. Owner/Agent Signature ^ Telephone No. PERMIT FEE:$75.00 \' 2f yY ( t r c6P-tg 4 GIB) '0 U6V/ / / !' �tMADC-G ��ryl ¶1( 49 :--, , 7 RECE_LyED •i,. JUL7, ; .,- L , ,, eosupsootavealk ol Madaeschossetb .2)epaptommat Wgiee Sowiced Ofal Use Only Permit No. t--.--1...,3 -0 Occupancy and Fee Checked RD OF FIRE PREVENTION REGULATIONS [Rev. I/07] (leave blank) BUILDING li 1.,,,; ' (VIE By ----- — 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 INFORMITION Date: 7/Ritz City or Town of: %. yer-retatAA 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) Z 3 Caili-1". ,weA.r- R.I. Owner or Tenant itiet, La Telephone No. Owner's Address t I Caeitaieil'ar" r-d. gr.-Aviv/h., Is this permit in conjunction with a building permit? Yes Ef No E (Check Appropriate Box) Purpose of Building Oat 12e0NOcit,I Utility Authorization No. Existing Service 100 Amps ite / NO Volts Overhead[9' Undgrd El No.of Meters I New Service Amps / Volts Overhead E Undgrd El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Tivarylt bodelmreowl. 4" aak.i- If+ Floor, Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires ,Swimming Pool gArnbody.e ri In- Li No.of Emergency Lighting L-I grnd. 1--J Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices _ . . Local Li Municipal r-1 other No.of Dishwashers Space/Area Heating KW "..',.. e-.-i Connection 1--1 No.of Dryers Heating Appliances; Kw , Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW Heaters . Signs Ballasts ,No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires Estimated Value of Electrical Work: tt qta (When required by municipal policy.) Work to Start: 7/j1 /ZZ. 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 Ey BOND 0 OTHER Li (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: ILienis Vag,4 Flearieun LIC. NO.: 4,, ,,.......,,,so...._.... ..--- Licensee: 2.74 ccet• rak,tig._ Signature LIC.NO.: 57 40-0 III applicable.enter "exempt"in the license numb r line,) Bus.Tel No.: Address: Zel orviwii 0. /I i O77 Alt.Tel.No.: *Per M.G.L.c. 147,s. 57-61,security work requi eparunent of Public Safety"S"license: Lic,No, OWNER'S INSURANCE WAIVER: 1 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 Ei owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ 25,00 1 \ The Commonwealth of Massachusetts t- Ari Department of Industrial Accidents s...qm._= 1 Congress Street,Suite 100 . Boston,MA02114-2017 "447 www.mass.govidia Workers!Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMUTING AUTHORITY". Anolicant Information Please Print Legibly Name (Business/Organization/Individual): ; tsr-ge."• FY&le_ Address: Zo Omkor-e4 54-, City/State/Zip: Gerk.Ifj AAA OZ77' Phone#: 544— 11(0 -iosr . 7 Are yea as employer?Climb tbe appropriate box: Type of project(required): • I am a employer with employees(full and/or part-time)• 7. New construction 2.E2Kam a sole proprietor or partnership and have no employees working for nit in 8. aketnodeling any capacity [No workers'comp insurance required] 9. El Demolition 3 I am a homeowner doing all work myself.[No workers'comp insurance required]' 10 El Building addition 4 I am a hoinein'vner and will be hiring contractors r-o conduct all work on my property I will ensure that all contractors either have workers compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees 12. Plumbing repairs or additions 5.0 tam a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14. Other 6 El We are a corporation and its officers have exercised their right of exemption per MG1...c 1 52,*1(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. *Homeowners who submit this affidavit indicating they are doing all 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. lithe 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.*site infonttation. Insurance Company Name: 145.60e rctiltsGA.44._ Policy tt or Self-ins. Lie. P(00. )17 . arn q Expiration Date: Job Site Address: Z3 a( ]..*CAN Wet(w- City/State/Zip: Yet-M.4k A4- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under IvIGL 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 certify under the pains and penalties o rjury that the information provided above IsIt4ie and correct. Sienature: Date: 7/4/ZZ Phone#: Slae —1,114 d5 -— — 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 Departmeni tity/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: