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Home My WebLink AboutBLDE-21-006383 a Commonwealth ofOfficial Use Only -> EMassachusetts Permit No. BLDE-21-006383 7 -- 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:5/5/2021 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) 14 FOREWIND RD Owner or Tenant MAGUIRE THOMAS J JR Telephone No. Owner's Address MAGUIRE JEANNINE C, 58 PLEASANT ST APT 2, BROOKLINE, MA 02146-3740 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: Screened porch addition. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ElNo.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 4 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/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 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: Scott L Carlin Licensee: Scott L Carlin Signature LIC.NO.: 52756 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:27 EDGEWOOD RD, CHATHAM MA 026331601 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 thel,,icensg,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: $75.00 ":"AQ' Vc2I4 ict74 sii: , eon oi Massackssetts Official Use Only 1. ,, Permit No. ' 2f -G g - 2.�4,34.Sr liked 11!_--.. Occupancy and Fee Checked ;,' BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massacirnetts Electrical Code(MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /114'1 o2e..3-Z I ^ City or Town of: W/14Lnl O(] ( t9 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) /y Foicw,,v,) TZ 0 8Owner or Tenant /'1/J/ 6-U/12.e Telephone No. , Owner's Address 5 e Pi c;p SA"Lir S(, `iRe, KO A)C Is this permit in conjunction with a building permit? Yes 02. No 0 (Check Appropriate Box) 2J- oay733 Purpose of Building 5c42 . rbec--pi Utility Authorization No. Existing Service Amps 129 /2-1(c)Volts Overhead® Undgrd 0 No.of Meters New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ash Location and Nature of Proposed Electrical Work: SC:gEf--)0C) I n; AGN ADD/A.26- ,.. q DD/A.2- Gl o UT4-6 r5 P,W t'L f .14"..) Completion ofthe fouowr rabl on,be waived by the Inspector of Wires. ; No.of Recessed Luminaires No.of Ceti.-Soap.(Paddle)Fans I NTranso.of Total formers KVA No.of Luminaire O� No.of Het Tubs Generators KVA No.of Luminaires Swimming pool Above ❑ In- ❑ No.or Emergency uguttng ,crud. und. nBattery Units No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones Detection and No.of Switches 1 No.of Gas Burners No.Inidelinq c No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste DisposersHeatPump Number Tons KW _ No.of Self-Contained Totals: Deteetion/A��Devices No.of Dishwashers Space/Area Heating KW Local 1--, M Conneefisa 0 Ohm Security No.of Dryers Heating Appliances KW of=or Equivalent No.of Water , No.of No.of Data Wig: Heaters Sips Ballasts No.of Devices or� � No.Hydromassage Bathtubs No.of Motors Total HP T elecontmunkadmis No.of Devices or _ OTHER: Attach additional detail ifdesired oras required by the Inspector of Ws,, Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start /hgy) G.021 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVEIi{AGE: 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 con ::a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE �!4 BOND 0 OTHER 0 (Specify:) I certify,ander the pains and, ofperjarry,that the information on this appficadon is tree and comms FIRM NAME: LIC.NO.: Licensee: SSD T Cwt 12L.1 id Signature -elLIC.NO.: al 7, 6'5 (lf applicable,enter"exempt"incla license number ' ) ( 062.6e- Bas.Tel.No.:779 a) 557 5 Address: IN PEP° / g 1 ic. GHl O 4'5 Alt.TeL No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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. 1 am the(check one)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ • The Commonwealth of Massachusetts ilk----- - ' Department of Industrial Accidents =Moil= = 1 Congress Street,Suite 100 r: -'11-T=_ -r Boston,MA 02114-2017 +',:,-,i5+`` www mass goy/din Workers'Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Anplicant Information Please Print Legibly 7� ( Name(Business/Organization/Individual): c-/ -,eL(A) Address: `7/ e / �j 77/j-,G)/C-F f 62 95 City/State/Zip: 7--1-4-AthGk/ .n,q,66/35 Phone#: 77 21-2 -5575 An you an employer?Cheek the appropriate box: Type of project(required): I ytny I am a employer with employees(hilt and/or part-time)• 7. 0 New construction 2. am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance ce rw ]t 9. ❑Demolition 4.11I am a homeowner and will be hiring 10❑Building addition • ❑ contractors to conduct an work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I .;74 Electrical repairs or additions proprietors with no employees. 1 .❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors Bated on the attached sheet These sub-cors have employees and have workers'damp insurance.: 13.❑Roof repairs sub-contractors 6.0We arearight per MGL c. 14.0Other corporation and its officers have exercised theirof 152,11(4),and we have no employees.[No workers'comp.insurance required.] *Arty applicant that checks box#1 must also 511 out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box must attached an additional sheet thawing the name of the s 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 employes Below is the policy and job site information. / , Insurance Company Name: 4Ff Ct. kit' ,'✓L)SC lam/', 64 iii frt.) ST, /li146L1CA 4550445 Policy#or Self-ins.Lic.#: /V 1?T .6 6 69' z_ Expiration Date: /0 02.J Job Site Address: /9 F5 26er 9//UD . 741414x(2771' City/State/Zip: 11110)151)71/ 1144 Q0, _‘7 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). J 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 ,; ,_O , ' of perjury that the information provided above is true and correct Si. store: ' '( d — 7 —24 Pane#: 77L/ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# i 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#: