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Home My WebLink AboutBLDE-22-000483 Commonwealth of Official Use Only .,I Massachusetts Permit No. BLDE-22-000483 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:7/27/2021 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) 303 PINE ST Owner or Tenant MCNIFF WILLIAM T Telephone No. Owner's Address MCNIFF MARY SULLIVAN, 13 ORIOLE RD, MEDFIELD, MA 02052 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: Installation of 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 18 No.of Luminaires Swimming Pool Above o In- ❑ No.of Emergency Li b O� grndgrnd. i Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALA' At114, o.oit?r,41., No.of Switches No.of Gas Burners No.of Detec 'fy.n Initiative Devic No.of Ranges No.of Air Cond. Total No.of Alerting Devi Tons 4V t) 8 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 ❑ %1 4: 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 Stens 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: Eric James Dill Signature LIC.NO.: 57051 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:20 Third Avenue, Bellingham MA 02019 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 (12N- 46 ''*/• 9/Z7/ i Aj/: Lc74 6 SLC d PoS{ p Q (.-1"="-/C__ /4f o1.--z7.16x4-eviL - S. t-,41'' 7 C as, Comm......t j Vatoac Official Use Only - t. ., c� Permit No.''',..---"Z---Z-'"–0 3 2 epartmant f.7fre swims Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK r All work to be performed in accordance with the Massachusetts Electrical C (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR PE INFOR TION) Date: 7 2...t rl Z I IMP City or Town of: UI l t(�O To the I pector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ?j03 R� ` . I- Ownner or Tenant R ;1\ f.f 1C t Telephone No._.!!L11 Owner's Address 5 71 - 3 -Pa,) Is this permit in conjunction with a building permit? Yes 0 No !A (Check Appropriate Box) ► Purpose of Building 6)9 mai )c Utility i, ,rization No. Existing Service 2.0 O Amps 20 /2 )Volts Overhead Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity , Location and Nature of Proposed Electrical Work: % • t, \ as U0. [c�+ n ()r \1�t Y � D cCo1 O V Completion of follow table m be waived by the 1 or ofWires. i nr)4- tbNo.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of �l � Transformers KVA 12) No.of Luminaire Outlets No.of Hot Tubs Generators i KVA I Pool_fund. In- 110.of Emergency Lighting k No.of Luminaires Swimming nd. ❑ mud. ❑ Battery Units `-1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and Z No.of Switches No.of Gas Burners -No.Initiating of Devices 11.1 No.of Ranges No.of Mr 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 C 0 Otl • Connec}on No.of Dryers Heating Appliances KW Security qqti No.ofS1D� 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 W nagg:s No.of Devices or Equivalent OTHER: Attach additional detail jdexired or as required by the Inspector of Wires. Estimated Value o Electrical Wo • (3 2 7 6 , `") (When required by municipal policy.) Work to Start:7 Z. Inspections to be requested in accordance with MEC Rule 10,and upon completion INSURANCE C VE E: 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 coy- 1 e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 171 BOND 0 OTHER 0 (Specify:) I certify,under the pains and,?�, , of perjury,th the information on this application is true and complete. FIRM NAME: r n J\O f i ( LIC.NO.: Licensee: /11 0. �I Signature C LIC.NO.: .5 7� - 1� (Ifapplicabl, r"i 1 e tic t' ./ y�� Bus.TeL No.• Address:'� ()l fll f/)/( 9 X DZ-((s 2 Alt TeL No.: i *Per M.G.L...417,s.57-61,security work requires Department 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. 1 PERMIT FEE:5 0-0 ,perzuLakia. The Commonwealth of Massachusetts Ta.,Pef 000[ ,_W r/ Department of Industrial Accidents . 7--=.17101`...—E--- 1 Congress Street, Suite 100 _'��= Boston, MA 02114-2017 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): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 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. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑Demolition ❑ y [No v'orkers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractor*to conduct all work on mYproperty. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am 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.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§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. t 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. 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: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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): I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: