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Home My WebLink AboutBLDE-21-006930 V Official Use Only + co Commonwealth of • i.,e,;15Massachusetts Permit No. BLDE-21-006930 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:5/30/2021 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) 1096 RIVER ST Owner or Tenant Lars Olson Telephone No. Owner's Address MA Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 N I . i` : •rs New Service Amps Volts Overhead 0 Undgrd 0 No. ,7 A 0 Number of Feeders and Ampacity 0 yr:0, Location and Nature of Proposed Electrical Work: Rough/final for addition&generator installation. Com letion ofthe followingtable maybe waive A iec o s. p No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of I Transformers �• No.of Luminaire Outlets No.of Hot Tubs Generators 1 ! er2 i No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 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 ❑ 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 Data Wiring: Heaters 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: 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: MATTHEW COSTA Signature LIC.NO.: 22688 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 196 REED STREET, NEW BEDFORD MA 02740 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: $200.00 Ce I t le ( fiZ6 aV Iva r-V E4 2 a 9447(1 5 t I Wu21 a/s CA! Wouzivr ci,oe (:-----eti2i. 91 tebk—i -reove1-1 <'arr . - /Z n c.2 C S '�r,7�-`‘ " V20(2) th-ck,-t-.4,48(ti (2,1 [:x� i Commonwealth* Maddaclutdeild Official Use On ,, n _ ,/ cc�� ci Permit No. rb _ ..CJspartnssni o`Jime Serviced Occupancy and Fee Checked .' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) E 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: ' 4 I a City or Town of: Ar1Y10U i4 To the Inspector of Wires: 2 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. '1-. Location(Street&Number) I 0 9 P, 12.1 Vc f Si- 0 Owner or Tenant /6,15 V, nisun f1411 Telephone No. CIOwner's Address 101 B 1?;vc,• 5414,4-, •i 1Is this permit in conjunction with a building permit? Yes No 1:1 (Check Appropriate Box) Purpose of Building Ag*ion. / 4or. Existing Service Amps Utility Authorization No. / Volts Overhead El Undgrd❑ No.of Meters N Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampaclty El Location and Nature of Proposed Electrical Work: o ugh i- finish wire of s"d i• f i nA ,„ I, I1 • ■ il a I. . k _ 11 hila , /, .' I .'rah( Completion of the followingtable mi be waived by the Inspector o ires. k.1-ill No.of Total U} No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of l�mergency Lighting 4_ No.of Luminaires Swimming Pool ted- ❑ fid, ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices 1 i No.of Ranges `No.of Air Cond. Ton l No.of Alerting Devices Heat Pump Number Tons _KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Aler Devices MunicipalOtheY, No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Heating Appliances KW -Securfty Systems.* No.of Dryers No.of Devices or Equivalent No.of Water No.of No.sof KW Data Wiring: Heaters Signs No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: ,t .. Attach additional detail if desirect or as required by the Inspector of Wires. Estimated Value of lectrical Work: £,WO." (When required by municipal policy.) Work to Start: 3 zo2 i Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAGE: 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 g BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the Information on this bort is true and complete FIRM NAME: M Q}•j'h GAJ cc)Stet LIC.NO.: '. (O 8 Licensee: Signature LIC.NO.: S g LI (If applicable,enter"exempt"in the license number line.) Bus.TeL No.: Address: Alt.Tel.No.: *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 Ari Department of Industrial Accidents ./11 ` 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): M o t h 1 I e Lh i C ) C Address: 9 - 136 9 ham S City/State/Zip: New BCde-o r a AAA O1 -i 0 Phone#: 'j b 8 - 1 11 - 9 a I Are you an employer?Cheek the appropriate box: Type of project(required): I.%I am a employer with 3 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself 9. ❑Demolition [No workers'comp.insurance required.]t a. I am a homeowner and will be hiring10 ❑Building addition ❑ contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑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. These sub-contractors have employees and have workers'comp.insurance? 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption14•❑Other �§ ( ) gh pti per MOL c. 15 14,and we have no employees.[No workers'comp.insurance required.] *Arty 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. tContractors 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: 1h4fta r'`'f rd Policy#or Self-ins.Lic.#: 1 tO S FjU 12,p t1 $Si Expiration Date: 1 -41 [9.I1 Job Site Address: 10 q Fj K.I yr r St City/State/Zip: la rrn 1)u th t M) o a(p to l 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under underndeuies of perjury that the information provided above is true and correct. Signature: Date: ' 1 a I )al Phone #: 50$ - 1 11 - q&.1 3 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): 1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: OY.Y1141 TOWN OF YARMOUTH BUILDING DEPARTMENT p .)' . y 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1263 Fax 508-398-0836 K. Elliott, Inspector of Wires kelliott(uivarmouth.ma.us August 5, 2021 Matthew Costa 196 Reed Street New Bedford, MA 02740 RE: Permit Number BLDE-21-006930 Dear Mr. Costa; The above noted location inspection failed to pass for the reason(s) listed below. • A300.4(A)—PVC conduit buried below grade must be a minimum of.18 inches below grade. Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained, to the property, for the re- inspection. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth, Building Department AJ Pulley, Assistant Inspector of Wires C: Ken Elliott • Tower ' i ' �rlr,rtll Ir�rrHrt�ltt�ttlrtFr,rrr�irt2.:':' 6Lt Z: :0172...?;r Building Department 1146 Route 28 prrp.L South Yarmouth, Massachusetts 02664 '` ' �` f $ 000.513 ASP. o via l2 1 � T � of 01.5 NIXIE Tug.N Tia NOTA43.1n 35 11NN$\-E 04632-j"'•a *1669` ` 1E`EE' 1 ilm'► i`ts`i Z _4.4, ,3, 1161'1'1`11"14itEi1EE111'01114111111 +� e L A-.4rri4Ew Csr4 Net, 17c►�i=v�ii� , ;AAA AN K 1 02664>4463 $ a •