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Home My WebLink AboutBLDE-22-002370 Commonwealth of Official Use Only '^ E Y0Massachusetts Permit No. BLDE-22-002370 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:10/25/2021 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) 15 CROMWELL DR Owner or Tenant GYSS GARY J Telephone No. Owner's Address GYSS JANET G, 32 FRANKLIN ST, RAMSEY, NJ 07446 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: 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 KV,A 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 Initiatine Devices No.of Ranges No.of Air Cond. Total n No.of Alerting Devices 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 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 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:238 SHERI LN, S WEYMOUTH MA 021901254 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 CeS 91 -2A k;: ...--. & Conunonwonifi o/N4eeachumils Official Use Only v/ `��oa'tew"t ti Permit No. E liZ� 2�7(V '1-'`. ti ` Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank)4 �. APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Ekctrica1 Code(MEC),527 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /0 1)i a/ City or Town of: %/Vjil 061-74- To the Inspector of Wires: By this application the undersigned glues notice of his or her intention to perform the electrical work described below. Location(Street&Number) / ' 64--ami,i e.// Pi,: Ua Owner or Tenant G-AiL y 4.,y5--is- .,y5'S Telephone No.ac,),-ya t j C .10 0 Owner's Address s C�M we I/ P2/ ,l /i -4, .moi 'i Yi Is this permit in conjunction with a building permit? Yes'1 No/ET (Check Appropriate Box) t 5 Purpose of Building ge S t �,,.v Utility Authorization No. al O' / ✓ �j Existing Service /((/ Amps --212/ / ,Volts Overhead ElUudgrd Er---- No.of Meters l ns ( New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ashy / Location and Nature of Proposed Electrical Work: ril /N A 66 CCM k-* OGS 0113 La &i2X CA, 174r /=ion it me-€ 9 L wk, , ate:. Completion of die famvinttabk Now be waived by dm InseeMar 4Wires. No.of feed No.of Recessed Lioninarres No."(Celt-Sem.(Paddle)Fans Transformers KVA No.of Lam Ostids Ns.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ Bat No.of Emergency l.tgitting and. �,rud. Battery Units No.((Receptacle Outlets / No.of OH Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners Na of DetectioInitiating n and Ns.of Ranges No.of Air Coad. TotaloNo.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of No.of Dishwashers Space/Area Heating KW Local 0 CMen.e d" 0 Other • Heating KW No."(Dryers bgecurity Ns.of=or Equivalent No.of Water KW No.of No.of Data : Heaters KW Balers No."(Devices or mmunications No.Hydroe Bathtubs No.of Motors Total HP Teleco No.of Devices or Eq t OTHER: Attach adtlitional detail rfdesired or as required by the Inspector of Wires. Estimated Value of Work:4 • , (When required by municipal policy.) Work to Start a ,,..- to be rested in accordance with IEC 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 cov,tge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEEll ND 0 OTHER 0 (Specify:) I certify,ander the pdes and penalties ofperjrtry,that the lam,on this appl y is true and cow FIRM NAME: Kevin A Cronin-Electrician t udAyjn A Cronin-Electrician Licensee: ne f � _. I Uousts Lane of applicable,enter - - Bus.T cath;ib1�4 02664 Andres: ex 1 7c Ale-Tel. T 76A. P. 781-812-557E ;Per M.G.L.c. 147,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. I PERMIT FEE:$ The Commonwealth of Massachusetts N. I�s�_ r t Department of Industrial Accidents u~ 1 Congress Street,Suite 100 " Boston,MA 02114-2017 www,neussgov/dia 4 Workers'Compensation Insurance Affidavit:BeildeisJContra lumbers_ TO BE FILED WITH THE PERWTFING AUTHORITY. Applicant Information Please Print Legibly Name( Orpnization/tndividuat): Kevin A Cronin-Electrician / LieTS Lane Address: South Yarmouth , MA 02664 Lis.11276A. P.784 812-5579 City/State/Zip: Phone#: Are you an emPbRr Check the appropriate box: Type of project(required): I.fl tam a ec oyer with employees{fob and/or part-time).* 7. ❑New construction 1 I am a sole proprietor or partnership and have no employees working forme in 1c. ...- 8. 0 Remodeling any aFP'.[No*Takers'comp.insurance regtired] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.0 Ian a honrcaoner and will be hiring contractors to caadnct afi vtodr on my property. I will 10❑,/ggllding addition ensure that all contractors either have workers'coenperreation insurance or rue sole 1 t 4 Electrical to s or additions Prof with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general cantnetor and I have hoed the act=listed on the attached sheet These sub-ooat adcamp.insurance.;nrs have employees and have workers' t 13_Q Roof repairs 6.0 We are a corporation and its officers have a ercaed urea right clearer:option per MGL c 14.0 Other I52,11(41 and we have no employees.[No workers'camp.insurance rammed.] *An),applicant that checks box#1 must also fill out the section below showing their workers'mon policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a rex affidavit iodieating such. ;Contractors that check this box must attached an additional sheet showing the Brame of the sub-contractors and state whether or not those entities have employees. lithe have employees,they must provide their waders'map.policy umber_ I mu an employer that is providing workers'compensation insurance for my employees. Below is the policy attdjob site information. Insurance Company Name: Policy#or Self-ins.Lic.if: 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 cert fy under the pains and p It the infoabaft provided abois tree and carred ronin-Electrician Ste: A / /7 `_....er art- 7 Lies Lane Date: Ar arr,Ir i— • 1 •1 $ , ,r' a .. Phone# Lic.11275A. P. 781-812-557£ Official use only. Do not write in this area,to be completed by city or town offidal. 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 i Contact Person: Phone#: