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Home My WebLink AboutBLDE-22-005667 Commonwealth of Official Use Only d ` Permit No. BLDE-22-005667 tfE Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:4/5/2022 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) 68 SALT BOX RD Owner or Tenant Peter Noone Telephone No. Owner's Address 68 SALT BOX RD, SOUTH YARMOUTH, MA 02664-2326 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: Renovations&upgrade panel. 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 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. 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 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 Signs 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. /vV r922 (�'r 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: James A Knox Licensee: James A Knox Signature LIC.NO.: 9629 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:236 WEST 26TH ST,RM 603,NEW YORK NY 100016789 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: $180.00 Leiii��C(' 1V2,10 4lvC, 13� t� � 0' tiar2,66- t4IS 7 (/zv40 (:: 1/17.14:3 ` .`e-er-1/4 Fei 1 eogstosv.tea-Ate r N tNedartiA' 0.--,1\10nFleD ' / m . RECEIVED ' APR U 4 2026 iii• !dl 4 Maddadiatietb Official Use Only �7� C� Permit No. *wiz Y ILDING DEPART = •' o�.ti�Jawic.d ', ` -- Occupancy and Fee Checked /,. : • ' - s • - -REVeNTION REGULATIONS [Rev. 1/07] (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 TYP ALL INFORMATION) Date: A—.4 -a0- City or Town of: 'C,rmri 11,-V1 To the Inspector of Wires: 4, By this application the undersigned ves notice of his or her intention to perform the electrical work described below. • Location(Street& umber) Gc2 a.i P II Owner or Tenant P-eki— N nor,e Telephone No. Owner's Address 5 in an �t Is this permit in conjunction with a building permit? Yes tNo 0 (Check Appropriate Box) 0 Purpose of Building e-PC c►(.-p n-ireS Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters c Number of Feeders and Ampacity 0 Location and Nature of Proposed Electrical Work: �y1.2 ee pif it re re rnr, i�s t ra..4 , L.� rang, 0t C , ).t1 YL. 1 Completion of the foiowingtable may be waived by the Inspector of Wires. Total lb No.of Recessed Luminaires No.of Ceil.-Snsp.(Paddle)Fans Tof Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. grad. Battery Units J No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initialing Devices 11.! No.of Ranges No.of Air Cond. Ton No.of Alertin Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals:_M Detection/Alerting`Devices No.of Dishwashers Space/Area Heating KW Local 0 Monnectlounicipaln 0 Other C No.of Dryers Hung AppliancesKW Security5y�s:* Nof Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or , alert No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications ' � I • No.of Devices or Emily nt OTHER: Attach additional detail ifdesired or as required by the Inspector of Wires. Estimated Value of Electrical Work: 9V1 DUD . — (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 co erage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 'l BOND 0 OTHER 0 (Specify:) I cerdjy,under Mie and- ,tablas of ,Mal the information on this application is true and complete.n FIRM NAME:a j(, - r ;l G C' LIC.NO.: vl cl A Lkenaee� n(TL S LIC.NO.:,2 R1 c.3 E (If applicableenter"exempt"in the :cense num line.) Address: h,,� Bus.Tel.No.• t'r J (�"o)� .SCS i- L /`►�E t� 1'4O , 74 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)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. ` PERMIT FEE:$ ,per \ The Commonwealth of Massachusetts , pik oa: l !/ Department of Industrial Accidents 1-i =:el` 5 1 Congress Street, Suite 100 'tir_ ' Boston,MA 02114-2017 '�^�;�4 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aaalicant Information Please Print Legibly Name (Business/Organization/Individual): V-Inoy, EA er-4r1(_1 i Plc . Address:P(') Ppm, ( I-7 City/State/Zip:�f t3P)P cRi-y-c)s 22 ) Phone#: )g C4f / ??j Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with 3 employees(full and/or part-time).* 7. 0 New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3. 1 am a homeowner doingall work myself t 9. 0 Demolition ❑ y [No workers'comp.insurance requires.] 10 0 Building addition 4.0 I am a homeowner and will be hiring contractor;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.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.0We are a corporation and its officers have exercised their right of exemption 14.0 Other � pti per MGL c. I52,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any 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:A pp( i erg t SY.... '.n stAro n cc. S9.n..)i(P_ , 1 in C . _ Policy#or Self-ins.Lic.#: 31— ) 1 Q(--)( - 01 j"). Expiration Date: ' D - I - Job Site Address: LOS 5a 1-1-box, City/State/Zip: Y(^ 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 the pains andpenaltiesof perjury that the information provided above is true and correct '� - / e Si•n- -: _AL/. Date: Q `4 -Da Phone#: Fbg •Ci,c) LP A- LQq 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#: