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Home My WebLink AboutBLDE-21-004748 Commonwealth of Official Use Only ,titer Permit No. BLDE-21-004748 Massachusetts 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:2/22/2021 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) 193 WHITES PATH Owner or Tenant MID CAPE RACQUET CLUB INC Telephone No. Owner's Address C/O MAJEWSKI ASSOC INC, 13200 OAKMONT DR, FORT MYERS, FL 33907-8030 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap I ro Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 .. i d •t Q New Service Amps Volts Overhead 0 Undgrd 0 • ° riI/ti0.Cdr Number of Feeders and Ampacity e Location and Nature of Proposed Electrical Work: Install fire alarm system. Q Q Q Completion of the following table may be waived b 44:• . •r of_Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 6° . Transformers 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 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting 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 Data Wiring: Heaters Siens 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 ❑ 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: Jamie S Popillo Licensee: Jamie S Popillo Signature LIC.NO.: 7017 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:6 Amanda's Trail, South Dennis MA 02660 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: $115.00 \\ Commonwsaith.el faeeacnuestts Official Use Only 7,37:4114-11 cc'�� cc77 {{�� Permit No. k` � _ TI. 2spartmeni a/.}irs JsraCeti 1�.-= Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (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 E (PLEASE PRINT IN INK OR PE ALL INF TION) Date: a'' I(J,91 City or Town of: 1110 To the Inspector of Wires: By this application the undersign lives notice of hi or per'1 a tion to perform the electrical work described below. 11111( Location(Street&Numb r) _ , ( , 1tAl i Owner or Tenant U j i OftWaWira IV�� a Telephone No. _ Owner's Address eiriffinflailrilliMalli A. 110 0 a Mg! $0 , Is this permit in conjyaction with a building permit? Yes No ❑ (Check Appropriate Box) . 3CIpi Purpose of Building(.0mrnytc'& Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters 4:::17 New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity 6 Location and Nature of Proposed Electrical Work:( 1-n reere,tol-R-�, Pri431 m SI4-an Completion of the followingtable may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans No f Traa onKVAsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimmin pool Above ❑ In- 0 No.of Emergency Lighting g _grid. Kind. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Ton No.of Alerting Devices No.of Waste Disposers Heat Pump Number_Tons KW No.of Self-Contained Totals: Detection/AlerDevices No.of Dishwashers Space/Area Heating KW Local 0 Muni ' 0 Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water , No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP TelecommunicationsofDeiceor qulva No.of Devices Equivalent OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Do Estimated Value of Electrical Work: (When required by municipal policy.) r— Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. (--6 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 te- undersigned certifies that such rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) t I certify,under a jiv.--t - ;i ties o pe •u , , the information on t is application is true and complete. /� 0 FIRM NAME: 711A l Aa, I A ss 0 • , LIC.NO.: 1017 C Licensee: nnrnl l�l 1 Signature LIC.NO.: l (If applicable, m 1 i um Address: n k � Wsfi � Bus.Tel.No.: '?'! r Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requ/Innis s 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 la By my si: e below I hereby waive this requirement. I am the(check one)0 owner ❑owner's a ent. Owner/Agen t A7 /, `a SignatureTelephone No.� 'N r ERMIT FEE:S (1 The Commonwealth of Massachusetts ►',_-5 1�V1. Department of Industrial Accidents 1E ' 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): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 1 am a employer with 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. I am a homeowner doingall work myselft 9. Demolition❑ ❑ y [No workers'comp.insurance required.] 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 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 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.* 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§I(4),and we have no employees.[No workers'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: Policy#or Self-ins.Lic.#: 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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 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#: