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Home My WebLink AboutBLDE-21-001045 c* Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-001045 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:8/31/2020 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 CAMPION RD Owner or Tenant JOAN CYR Telephone No. Owner's Address COLASANTI LEONARD M TRS, 14 CAMPION RD,YARMOUTH PORT, MA 02675-1560 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead CI Undgrd 0 No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 Ai etery Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement NC system(Attic). Completion of the following ay i '` 1 s e Wires No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 4r,t.' Transformers No.of Luminaire Outlets No.of Hot Tubs Generators R"t No.of Luminaires t �j Swimming Pool Above ❑ In ❑ No.of Emergency Lighting ,t/ grnd. grnd- . Battery Units A No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. 1 Total No.of AlertingDevices Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of evices or Equivalent Heaters KW Sins No.of Data Wiring: Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired,or as required by the Inspector of Wires Estimated Value of Electrical Work: Work to start: (When required by municipal policy.) 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, ,erry,u that the information on this application is true and complete. FIRM NAME: Charles K Swanson Licensee: Charles K Swanson Signature Tel. NO.: 12895 (If applicable,enter"exempt"in the license number line.) 'Address:718 CEDAR ST,W BARNSTABLE MA 026681300 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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. ` l I PERMIT FEE:$50.00 I *A- 1 1 A 9/Y( zo og 6 ( : ( D.404) qje../""--NA-' (M (- 44 ?Jr • Commonwealth of Massachusetts Official Use Only 1; Department of Fire Services Permit No. 2l -- 1 0 fi �{ .,_ { BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.9/05] (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 MINK OR TYPEr4LL INFOR&fATIo1V) Date: •R`- 2 Z .Z. ) City or Town of: yorwtoe-ch 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) lc( Cow,p ,.`� i. c1t Yo• 1'woo i 1n 6` ( . 3Incc Owner or Tenant • v, Ctt,r, Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No la- (Check Ap propriate Box) Purpose of Building ' 'Utility Authorization No. Existing Service Amps / Volts .Overhead❑ Undgrd❑ No.of Meters ' New Service Amps / Volts Overhead❑ Undgrd Ej No.of Meters Number of Feeders and A mpacity Location and Nature of Proposed Electrical Work: to U f-&.p((.c'e wv-,i.r A.i`i L Cot ty- rczc i pi S?(S Completion of the following table may be waived by the Inspector of Wires. Na.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 Olt Burners FIRE ALARMS INo.of Zpnes • No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. / Tom 3 No.of Alerting.Devices No.of Waste Disposers Heat Pump Number Tons f KW .., No.of Self-Contained Totals:I__....,...........[ ...w 1 .. Detection/Alerfing Devices • No.of Dishwashers Space/Area Heating KW Local 0Municipal • Connection_ ❑Off' No.of Dryers • Heating Appliances KW Security Systems:* No.of Water KW No.of No.of Devices or Equivalent No.of Heaters Signs Ballasts Data Wiring: • No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP 'Telecommunications Wirin • OTHER. No.of Devices or Equivalent • Estimated Vahte f Electrical Work - cc Attach additional detail if desired or as required by the Inspector of Wires. Weak to Start: '' .(When required by municipal policy.) 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 ®- BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of erJury,that the information on this application is true and comple FIRM NAME: eLop(`_,s Sc v\ $6,vk LIC.NO.: S Licensee: Signature n \ LIC.NO.:E 3 I G (If applicable,enter"exempt"#4 the li number line.) Address: - 7(? tit,'0N C C (, ) 8!`v1 S i c S(e-- l'1 . Alt.Tel. But.Tel.No.:tj?'�S� '�_Gl *Security System Contractor License required for this work;if applicable,enter the license number here:No.: n b OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage required by law. By my signature below,I hereby waive this normally Owner/Agent requirement I am the(check one)0owner El owner's agent • Signature - Telephone No. • • I PERMIT FEE:$ EMAIL ADDRESS: • The Commonwealth of Massachusetts • Department of Industrial Accidents 1 Congress Street,Suite 100 F: 1.4 y • Boston,MA 02114.2017 •• 4'11;00 w ww mas gov/die Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO RE PILED WITH THE PERMITTING Al:7110 T'Y. Annlicaut Information Please Print Legibly Name(Business/Organizationmtndividual): 1/�. k 5 5(.Jt�Ilk S O 1 Address: '7( Cm c904 City/State/Zip:td L3P1'\5 �4�j�e._ PAc.i Phone#: 6 ?— 0/6 ( Are you an employer?Check the appropriate box: • Type of project(required): 1 a employer with employees(full and/rpart-timne).* 7. ❑New construction 2 am a sole pnapzletoror partnership and have no employees working forme in • 8. 0 Remodeling . any capacity.[No work ts'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t g• ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work onmy property. I will 10 Building addition • ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I sin a general contractor and I have hired the sub-contractors listed on the attached sheet. These subcontractors have employees and have workers'comp.insurance; 13.E1Roof repairs 6.0 We are a corporation and its officers have exeicised their right of exemption per MCii.c. 14.0 Other • 152,§I(4),and we have no employees.[No workers'comp.insurance re aired.] • • *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all wadi and then hire ontsbde contractors must submit a new affidavit indicating such. 3Contractom that checktbis 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.Lie.#: Expiration Date: Tub 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 pnnishable 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$230.00 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 certi un er the pains and penalties ofperjury that the information provided above is true and correct Signature: J ` ?'3 `oto � Date: Phone#:Official use 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#: '