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Home My WebLink AboutBLDE-22-001147 ' et\ Commonwealth of Official Use Only ... Massachusetts Permit No. BLDE-22-001147 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:8/30/2021 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) 142 KATES PATH VILLAGE Owner or Tenant Mary Beever Telephone No. Owner's Address 142 KATES PATH VILLAGE,YARMOUTH PORT, MA 02675 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: Wiring for basement area. Completion of the following table may be waived by jiie Inspector of Wires. No.of Recessed Luminaires 11 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 14 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 No.of Alerting Devices Tons 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 0 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. 8.4'/2 -1.2.4.1 FIRM NAME: WILLIAM A TRACIA Licensee: William A Tracia Signature LIC.NO.: 15005 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:68 DERBY RD,P.O.BOX 219,BERLIN MA 015030219 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: $75.00 11 i2 L6-109-e #/2, E -- 14-3(0-1--L Nit►-() V 2424 Cox fxr( 114 s P / ex) re- ('-F >4 qeCi` (0-/C D-nx. a — "g0 e-►e—'uzw.a ) I clq121 -— eatk.. Commonwealth 0/Mae iachueet Official Use Only 14. Permit No. EPa . ( ( a �1_ .2)epartment o/.ire�erviceC) P _=- _ 5 Occupancy and Fee Checked U..1 A F— BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) PPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Uj jC _u 1 All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (;i cm 'L9(IEASE PRINT IN INK OR TYPEALL INFO TION) Date: $ - a7 - al Lt6 Q E j City or.Town of: kr To the Inspector of Wires: --1 BI this application the undersigned gives notice of his or her intention to perform the electrical work described below. LG m Li cation(Street&Number) i4a1 KA+gS ?D.}h •wner or Tenant ,MGI 7 Q GE✓t( Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service _ Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead n Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W e re,- P:i.i5 ri 10.4 G.M.. 4-- Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires 11 No.of Ceil:Susp.(Paddle)Fans Tf Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above r—i In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units 1 No.of Receptacle Outlets Iil No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. Initiatinnggon Deteand InDevices No.of Ranges No.of Air Cond. Total g Tons 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 t{ Local❑ Municipal ❑ Other L Connection i SNo.of Dryers Heating Appliances KW SecuriNo o Deices 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 NforWiring:qal No.of Devices Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 3 .'1;,5 0 0 (When required by municipal policy.) Work to Start: $• .7 • al Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE riz BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Q:l i Ile-(,:k. C i e(.,41--e°•I/ I ICS LIC.NO.: Licensee: Signature LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.• Address: r,$ Of r kg,' (fat ow I‘..)/ ,/A A t 01,563 Alt.Tel.No.: tt *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)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ (es., The Commonwealth of Massachusetts Department of Industrial Accidents , `r—' `' Office of Investigations _. Lafayette City Center t :. . .. 2Avenue de Lafayette, Boston,MA 02111-1750 j'l :''°' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 11. 11 t f GCaL C 1 °_C.1-+r• CAj '( C- ----- Address: 9•t . b cox City/State/Zip: Fief I.n i ,ri✓4,"� ol S C.•/ i Phone#: (i ou - 6 t a-- a Ltif Are you an employer? Check the appropriate box: Type of project(required): 1.L i am a employer with S 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' insurance. 9. Ill Building addition [No workers' comp.comp. insurance required.] 5. 0 We are a corporation and its 10.gElectrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *My 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: N 6 P Policy#or Self-ins. Lic. #: W C'1 O B 7 t-1 Expiration Date: / a Z-- Job Site Address: 1(14- K44-e45 Pcli-h City/State/Zip: `/A(PI Ot)O / A,- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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: g v a 7 - `, Phone#: $D8 - 6 i a- 2.29'4 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0 Other Phone#: Contact Person: