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Home My WebLink AboutBLDE-21-005392 lb or ��I Official Use Only a�vi Commonwealth of (Ai Massachusetts Permit No. BLDE-21-005392 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:3/19/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 74 JEFFERSON AVE Owner or Tenant NAPOLITAN CARLO L Telephone No. Owner's Address NAPOLITAN MARIE, 74 JEFFERSON AVENUE,WEST YARMOUTH, MA 02673 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel kitchen&gym area. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 16 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 32 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 14 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges 1 No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers 1 Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers 1 Space/Area Heating KW Municipal Local ❑ Connection 0 Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devics 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 I certify,under the pains and penalties ofperjury,that the information on this application is true and complete 8 �8J �� FIRM NAME: TIAGO N RIBEIRO Licensee: Tiago N Ribeiro Signature (If applicable,enter"exempt"in the license number line.) Tel. NO.: 14640 Address:5 Highland St, Milford MA 017572313 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 Owner/Agent ) 0 owner CI owner's agent. Signature Telephone No. I PERMIT FEE:$75.00 I 1\114 Ci312k ece_76ct gpAci4 vr-7/24 l /1161fr igtoi Cii/7/2-1 ,Ifl --) - 1 —� n _ )--2-0-24 � Commonwealth.o////asoachu4ette Official Use Only �i= % .2 epartment o/.7ire Services Permit No. L — J / `f- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked '� [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 TYPE ALL INFORMATION Date: 3— 17 City or Town of: Yoi r nnou f l 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) 7 II �c 1f)ef'son A (/�e Owner or Tenant Qo ( "��C h ne7\sr ell, Telephone No. 6S-77 as-0 i Owner's Address Is this permit in conji ion with a building permit? Yes Purpose of Building d No ❑ (Check Appropriate Box) ' Pin Utility Authorization No. Existing Service /00 Amps 1.0-0/.2 Volts Overhead F1 Undgrd g ❑ No.of Meters f New Service Amps AQ.O 4.71 Volts Overhead 4 Undgrd g ❑ No.of Meters ) Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ti c nRP modle ( � gascn�e�4 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires i 6 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 ...3.2_ No.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches i No.of Gas Burners No.of Detection and No.of RangesTotal Initiating Devices j No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers ) Heat Pump I Number I Tons I KW No.of Self-Contained Totals: r j Detection/Alerting Devices No.of Dishwashers J Space/Area Heating KW Local❑ Municipal 1 Connector ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of Heaters KW No.of Data Wiring: Signs 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: c a40 (When required by municipal policy.) Work to Start: 3,.- 17 --2I 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 rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE all BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofp perjury,u that the information on this application is true and complete. FIRM NAME: G __ 11 �' 44- ►�U NLIC.NO.: i/14°I0 Licensee: �f co ' .:10B%Yt, Signatur (if applicable,enter"exempt"in the license number line.) LIl. NO.: Address: i at��otPoQ ��,� k\tup, O�S,6 , Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security" work requires Department public Safety"S"License: Alt. No.: No.l. . SOS �,�lz �9�/y 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)El owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ J The Commonwealth of Massachusetts - - Department of Industrial Accidents -- ti - f • Office of Investigations • ; Lafayette City Center di 2Avenue de Lafayette, Boston, MA 02111-1750 g§ www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Print Legibly Applicant Information Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate❑b I am a general contractor and I Type of project(required): 1.❑ I am a employer with4 have hired the sub-contractors 6. ❑New construction employees (full and/or part-time).* 7. Remodeling listed on the attached sheet. 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. 0 Demolition ship and have no employees employees and have workers' 9. 0 Building addition working for me in any capacity. comp. insurance.t [No workers' comp. insurance 10.0 Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions right of exemption per MGL 12.0 Roof repairs myself. [No workers' comp. c. 152, §1(4),and we have no insurance required.]t 13.0 Other 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. 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: Expiration Date: Policy#or Self-ins. Lic. #: City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy 25A of MGL c.eclaration page 5 2 can 1'ead to the ing the policy mpos imposition of cumber riminal penalties ofa Failure to secure coverage as required under Section fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties es statementnthe form may be fSTO oft h O cRoand a fine that a of up to $250.00 a day against the violator. Be advised copy of this f 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. Date: Signature: 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(check one): 10 Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Phone#: Contact Person: