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Home My WebLink AboutBLDE-22-002372 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002372 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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) 7 DEBS HILL RD Owner or Tenant Kathy McPhee Telephone No. Owner's Address 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 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. Ton l No.of Alerting Devices TNo.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Eauivalent 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 emounoww eJ4./Meacham& Official Use Only Permit No. C'L��Z37�, • _ .J .parfweat./.74.. �y and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] ( ) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical code / .527 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /c)/c)-1-1c9/ City or Town of: YA-r7/n pct-r I To the Inspector of Wires: By this application the undersigned ves notice of his or her intention to perform the electrical work described below. Location(Street&Number) 7 DE-7-. ' S hii G L C Owner or Tenant '7)-�r di c p 2 Telephone No. QUA 51r c .tri 0v V, Owner's Address 7 I�,G ' 5 �/ L L y/�'17! T V t Is this permit in conjunction wi h a building permit? Yes ❑ No [ (Check Appropriate Be:) a) o' Purpose of Building 62e3 %j u> Utility Authorization No. u, °4 Existing Service 1 r�j Amps /20-i ayJ Volts Overhead 0 Undgrd 1:a--- No.of Meters f New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters I Number of Feeders and Ampactty al//A Location and Nature ofProposed Electrical Work: /77//✓04 EGA Cit (C 92 , cM" (-h i l/ r.✓t k OH 77x�T r=ut �i /Ar.� (race t L \ Completion ofthefollowinglkezbe waived by the Invader of Wires. No.of Recessed Lumimdres No.of CeE.-Snsp.(Padile)Fans uta! Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Lumlnaires Swimming Pool Above ns ❑ In- ❑ No.of Emergency l tg>ttiug irn& grad. Units No.of Receptacle Outlets 1 No.of Oil Burners 'FIRE ALARMS N..of Zones No..f Switches No.of Gas Burners 'No.of Detection and , Iniirl�iag Devices No.of Ranges No.of Air Cond. T otal 'No.of Alerting Devices N..of Waste Disposers "Heat Pump Number Tons KW -No.of Self-Contained No.of Dishwashers Space/Area Heating KW Local❑ MA�Cennecbf.Jn 0 Other No..f Dryers Hag Appliances KWa �of eD vias or Equivalent No.of Water KW No.of No.of Data : Heaters Sim Ballasts No.of Devices or No.Hydromassage Bathtubs No.of Motors Total HP T No.of Devices or Fq t OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Work:thfrO :(fr (When required by municipal policy.) Work to Starr U at1" a 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 cov is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEiff ND 0 OTHER 0 (Specify:) I cerdfr,ander the pains and penalties ofpesjnr,that the information on this 1.,e is true and complete. FIRM NAME: Kevin A Cronin-Electrician LIC.Nf Vin A Cronin-Electrician Licensee: 7 Liefs Lane g:,, , •. / C i Liets Lane (If applicable,enter"exemptsA X 9i i} be Q2','. i,� dt+ l- a ea MA 02664 Address: Lic.11275A. P.781-8122 557: -Tei-NEib.T12-7611. P. 781-812-557E Air.Tel.No.: *Per M.G.L.c. I47,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)❑owner 0 owner's agent. / fit Signature Telephone No. I PERMIT FEE:$ l The Commonwealth of Massachusetts i``— ,, Department of IhdustrialAccidents -44:77.0 , I Congress Street,Suite 100 _ � Boston,MA 0211¢2017 , twww mass.gov/dia Workers'Compensation Insurance Affidavit Builders/Contra lumbers. TO BE FILED WITH THE PERMITTING ADTHORII'Y. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Kevn t A Cronin-Electrician Address: 7 Liefs Lane South Yarmouth , MA 02664 Lic.11275A. P. 781-812-5579 City/State/Lip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): L❑I am a m pbyer with smpioyees(full and/or part-time).* 7. 0 New constriiction 2 Iam a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp_insurance required.] 3.01 am a homeowner doing all work myself[No workers' t 9. ❑Demolition 10❑Building addition - tip tam a homeownez and will be hiring contractors to eondractan want on my property. I will ensure that an contractors eats have workers'compensator insurance or are sole 11.rd a -..'• repairs or adcrstions proprius with no employees. 12..Plumbing repairs or additions 5.01 am a general contractor and I have hared the listed on the attached sheet 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: ❑ 6.0 We are a emparatiam and its officers have exercised their right of exengitian per M(':I.c. 14.❑Other I52,l I(4),and we have no employees.[No woida;rs'comp-instuance required.] *Any applicant that sheets box ill must also fill out the section below showing their workers'motion policy information. t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit imdieatag 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_ 1f the sub-cootrachas have employees,they most provide their waiters'sump,policy number I am an employer that is prove ing 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/StatelEm: 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 tial violation punishable by a fine up to$1,500.00 andfor 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 rte thepains and pe rdhiiec of isiffatialf re n provided above is and correct Signature: �, 7 Liefs Lane /C) /true Phone#. Lic.11275A, P. 781-812-5579 Official use only. Do not write in this area,to be completed by do or town official City or Town: Permit/License# AIssuing Authority(circle one): 1 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 1 6.Other Contact Person: Phone#: