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Home My WebLink AboutBLDE-21-005382 �a .x `� Commonwealth of Official Use Only t``�. i Massachusetts Permit No. BLDE-21-005382 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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:3/19/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 31 UNCLE ROBERTS RD Owner or Tenant KENT MALCOLM P TR Telephone No. Owner's Address ROSE COTTAGE NOMINEE TR,46 ABORN ST 4TH FLR, PROVIDENCE, RI 02903 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 generator&transfer switch. 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 14 No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALAR .of Zone, No.of Switches No.of Gas Burners No.of • t n a kik. C . Initiat' is es No.of Ranges No.of Air Cond. Total No.o t t ,g iliii'ripel..-- Tons No.of Waste Disposers Heat Pump Number Tons KW _No.of Self-C 8 , Totals: Detection/Alerti I ev• No.of Dishwashers Space/Area Heating KW Local 0 Municipa{{�.// eiV Connection No.of Dryers Heating Appliances KW Security Systems:* . No.of Devices or Eauivalent 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 Wiring: No.of Devices or Eauivalent 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: MARCELO R SOARES Licensee: Marcelo R Soares Signature LIC.NO.: 13036 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:53 FALMOUTH SANDWICH RD, MASHPEE MA 026494307 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 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: $80.00 Na 6.,., IocA- 3/7'11z-4 - Commonwealth of Massachusetts Official Use Only_ e Department of Fire Services Permit No. " Occupancy -�-`-- BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05c d Fee Checked 4=, .,` j (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) Date: C? I f Y. 12-1 City or Town of: 10-AAVu1k 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) ?)1 !;}N(/I,i 1-7\21')°q/1) -'7 w• / ou Lit.in4 Owner or Tenant /\/\ 1 M ii---V—n,r Telephone No. Ln-e14. of- 6ct,(; Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. 3 Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters V New Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters Number of Feeders and Ampacity : Location and Nature of Proposed Electrical Work: IA- \z-vo G----n.t11_i--iv,(L tti k-rl� t.(%j'b 1 V-piSJSsL ‘D"J.4 I-- ‘k vCompletion of the followin&table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total VA Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting and. grrnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones c-' No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons 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❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Heaters KWData Wiring: _ _ Signs Ballasts 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: 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. X CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) 2 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. GFIRM NAME: VA-4-GC1.J V- �p-t- t -ti CTR. -C 1� LIC.NO.: 1*--j '-'*� 6- A� 6' Licensee: Signature LIC.NO.: 27,-64c1- P C_ j (If applicable, enter"exempt"in the license number line.) Bus.Tel.No.: 1t'`?,'3(�-19'639 Address: Alt.Tel.No.: 2 -4_; *Security System Contractor License required for this work;if applicable,enter the license number here: 0 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability ty insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts „hl, Department of Industrial Accidents 1 Congress Street,Suite 100 ;}_ � Boston,MA 02114-2017 www mass.g i /dia Workers'Compensation Insurance Affidavit:B,• ders/Contractors/Electricians/Plumbers. TO BE FILED WITH'an,P • I TING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/ .te/Zip: Phone#: Are you an •..•toyer?Check the appr.\nate box: Type of project(required): 1.Q I am a .•. .yer with employes( and/orpart-time).* 7. ❑New construction 2.0 I am a sole. .. 'etor or partnership and ha`' no employees working for me in 8. El Remodeling any capacity. ,workers'comp.'. •..e required.] 9. El Demolition 30I am a homeowner..ing all work my•-If.[No workers'comp.insurance .. , t 10 0 Building addition 4.0 I am a homeowner and'will be.. '.1 contractors to co.duct all work on my. .perty. I will ensure that all contractorieither •ve workers'comp.. ,on insurance or.r sole 11.0 Electrical repairs or additions proprietors with no employ...-. 12.Q Plumbing repairs or additions 50 I am a general contractor••.I• ve hired the sub-contractors I. _. on.•e attached sheet. 13.❑Roof r-.airs These sub-contractors,• e emplo ees and have workers'comp. "ie.• e.t 6.0 We area corporation•..its officers <ve exercised their right of a ..'•.tion per MGL c. 14.❑Oth; 152,§1(4),and we..veno employees.' o workers'comp. • .,ce >• ' ] *Any applicant that ch- ..box#1 must also fill o .the section below a.owing their•orkers'compensation policy oration. t Homeowners who •..t this affidavit indicating r are doing•.work and then •outside contractors must: bmit a new affidavit indicating suck tContractors that .eck this box must attached an addi.•nal sh-- ,owing the name of th. •-contractors an. . . -whether or not those entities have employees. If the sub-contractors have employees,they .vide their workers'comp. .•licy number. I am an employer that is providing workers'c. .enation insurance for my . ' oyees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiratio. Date: Job Site Address: City/State/Zip: Attach a copy of the workers' ompensation policy decl• • ;on page(showing the policy n mber and expiration date). Failure to secure coverage as uired under MGL c. 15 ,§25A a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonm=•t,as well as civil penal+' s in the fo .. •f a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A'copy of this statement ay be forwarded the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and pen'I ties ofper'ury that the information provided above is and correct Signature: Date: Phone#: . Official use only. Do not write this area,to be completed by city • town official City or Town: Permit/Licens• Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical b=spector 5.Plumbing Inspector 6.Other Contact Person: Phone#: