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BLDE-22-006172
\� Commonwealth of Official Use Only gt-Massachusetts Permit No. BLDE-22-006172 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:4/27/2022 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) 243 WOOD RD Owner or Tenant Mary O'Reilly Telephone No. Owner's Address 243 WOOD RD, SOUTH YARMOUTH, MA 02664-4253 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: Receptacle for fire place blower. 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 1 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/Alertinc Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Siens 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: KEVIN A CRONIN Licensee: Kevin A Cronin Signature LIC.NO.: 11275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:7 Liefs Lane, South Yarmouth MA 02664 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 C c J4),? tzg,„ • ComalowsmrA o/MaiMischis641.15 Official Use Only 1 - ' .[JsParfwhawE o�.trrs Permit No. ~ -' nd c BOARD OF FIRE PREVENTION! REGULATIONS [Rev_Occupaniro7Jcy a(> Fee yCheam}ked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wwck to be performed in axorchmce with the Massachusetts Electrical Code 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / , ,/___ City or Town of: �/�-2 h1 cu � To the Inspector of Wires: By this application the undersign l gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) e9V 3 GV U0I7iZL: @j Owner or Tenant m V a `L2..1/ Telephone No. $ (p6), (---- c �f J ,c E • Owner's Address ' cz (/3 j.4Jo. D /7c,/�� . u u i Is this permit in con °�°°with a building permit? Yes ❑ No fj' (Check Appropriate Box) tp s Purpose of Building dc.4.,c_e__ Utility Authorization No. • C Existing Service/6.C./ Ampso?`/V/AO Volts Overhead©/Uudgrd❑ No.of Meters I) 4+ , ro O 1 New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity MA Location and Nature of Proposed Electrical Work: &/Nom- /9- /„) 0 Z 0 GO cr2/C OU 7z el- Gil 6-frs f .-(9e s,i N G ftp: c-.L C,. ii), .1 N 0)1412, Completion of thefollowingrable mist be waived by the Insfiector of Wires. -. No.of Recessed Laminaires No.of Cei.-StdT .(Paddle)Fans r of Total Transformers KVA C=' No.of Leminaire Outlets No.of Hot Tubs Generators KVA No.of Lamiaaires g Pool Above ❑ In ❑ P40.or Units ey Lighting grad. grad. Battery Unita No.of Receptacle Outlets 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and c Feting Devices otal No.of Ranges No.of Ala Cond. T 'No.of Alerting Devices No.of Waste Dispa:ers 'Beat Pump Number Tons KW 'No.of Self-ContainedIertlnD No.of Dishwashers Space/Area Heating KW Local 0 evices Co�I 0 Other No.of Dryers HeatfngAppliances ' Security Systoles:* No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring. Heaters Signs Ballasts No.of Devices or - ,• t t NaBathtubs No.of Motors Total HP T n , , . HydromassageNo.of Devices or - , , t OTHER: Baf-c) Poo 6fis 74c5 7 4Xlol 1 Attach additional detail rf'desired or as required by the Inspector of Wires. Estimated Value of 1 Work: O (When required by municipal policy.) Work to Start — Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE OVERAGE: 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 covpage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE aia BOND❑ OTHER 0 (Specify:} I�,ander �Lf i"ra1hI*aI the information on this application is true and complete. FIRM NAME: 71 iefs Lane / , LIC.NO.: //.) ? 04 Licensee: South Yarmouth , MA 02664 Signature - afv2_ t�— LIC.NO.: )y i?s (lf applicable,enter i 1Me 1F�ec78b+8g ASSO Bus.Tel.No.: '7 k I k(�S515' Address: ' Alt Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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 ❑owner's agent Owner/Agent I PERMIT FEE:$ Signature Telephone Na. The Commonwealth of Massachusetts 11,!--11-1-=-=...="' Department of Industrial Accidents u = 1 Congress Street,Suite 100 � Boston,MA 02112017 www.mass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TILE PERMITTING AUTHORITY. Applicant Information PIease Print Legibly Name(BUsiness/or odindi„id in A Cronin-Electrician Kaccicctrician© 7 Liefs Lane Address: South Yarmouth MA 02664 outlook.com Lic.112T5A. P. n31-812-557 City/State/Zip: Phone#: Kevin A Cronin-Electrician 71kfsIam_ Are you as employer?Check the appropriate box: SOUttLYarmouth i MA U1ti64 LiG 11 i7VA 4PRIf4 = t.®I a emptvsres with (full and/or part-time).* ?. ❑New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'coin.uatnance required) 3.❑I am a homeowner doing all work myself[No workers' t 9. ❑Demolition �P•insurance required] _ 4.0 I am a homeowner and will be hiring contractors to conduct all work an my pmpaty. I will 10❑B+ '_addition ensure that iwith contractors either i he have woes'comp�tian insurance or are sole 11.IM O =*.i y.. repairs or additions proprietors a 12.❑Plumbing repairs or additions 5.0 I��a�t I have hired the listed on the attached sheet 13. Roof repairs employees and have workers'comp.uulasnce.t ❑ 6We are a=potation and its officers have exercised their right of earaeptian per MCd,c. 14.❑Other 152,41(41 and we have no employees.[No workers'comp.insinemee rewind.] *Any applicant that checks box#1 must also fill out the section below showing their workers'man policy information t Homeowners who submit this affidavit indicating they we doing all work and then hue outside contractors must submit a new affidavit indicahog 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 s have employees,they mast provide their workws'comp.policy=ob r 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 if or Self-ins.Lic.it: Expiration Date: Job Site Address: City/StaterEp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to sage coverage as required under MGL c. 152,§25A is a criminal violation pimishable by a fine up to$1,500.00 and/or ono-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 certiA wader the pains and penalfres of perjury that the information provided is re and purred Kevin A Cronin-Electrician l Si:?nature 7'e� 7 Liefs Lane Date: c)G -0)-- Phone EJ South Yarmouth , MA 02664 I ir•. 11275A P 781-R19-sri79 Official use onlj Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): j 1.Board of Health 2. g Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other Contact Person: Phone#: