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Home My WebLink AboutBLDE-23-000570 Commonwealth of Official Use Only fe*or Massachusetts Permit No. BLDE-23-000570 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:8/3/2022 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) 52 PRINCE RD Owner or Tenant PAUL CRUZ Telephone No. Owner's Address 52 PRINCE RD,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 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Septic Pump&Alarm 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 Initiatine 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 1 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors 1 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: Wayne N Diamond Licensee: Wayne N Diamond Signature LIC.NO.: 37015 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 10 BLUE HERON CT, EASTHAM MA 026423341 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: $50.00 % \%-l)DV I )t$t v/ &k- c Si" RECEIVED AeotQQt�c1 / rAIiT Comiuveaola� cltuaettdOfficial Use Only �� j� J1 7o *1 t7 cc�� cc77 Serviced Permit No. C.�� 2 artment o .yire Serviced BUILDING i !•I _ ENT O0ARD OF FIRE PREVENTION REGULATIONS [Rev. 1/0]yandFeeChecked �� (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: g ,a c2c.014, City or Town of: Ar rno tAi To the Inspector of Wires: By this application the undersigned fives notice of his or her intention to perform the electrical work described below. Location(Street&Number) '' r,t torte )2�. Owner or Tenant 41 l L (ri)Z Telephone No. Owner's Address SA re,G- Is this permit in conjun on with a building permit? Yes n No M (Check Appropriate Box) Purpose of Building p �'S t Yx•'Ju L`e Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead I I Undgrd❑ No.of Meters Number of Feeders and Ampacity Location d Nature of Proposed Electrical Work: kJ//. 5,c,in. i .3 •2 ,0�rr �u rii 1,r5 1..3.C-rr FX,5.-CI . r)Ai nr1gi tvla-t -S �i Completion of th following table mlty 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 r 7 No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Abo In- ❑ No.of EmergerCy L g ."ng grnd. n-d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of .Ines No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. TOns No.of Alerting Devices No.of Waste Disp:sers Heat Pump Number T.ns KW No.of Self-Conta'1 Totals: Detection/Alerti. . Devices No.of Dishwash• s Space/Area Heating W Local Mu 'cipal ❑ Co,nection ❑ Other No.of Dryers Heating Appliances KW Security Sys •ms:* No.of Water No.of Devi : or Equivalent No.of No.o Heaters KW Signs Ballasts Data Wiring: g 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:-AL`7'0"6'O (When required by municipal policy.) Work to Start: 7 a8. ,9a Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VE GE: 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 f BOND ❑ OTHER ❑ (Specify:) I certify,under the plainly and penalties of perjury,that the information on this application is true and complete. FIRM NAME: &...49 yjUC_f i tc) M 0. --A )JU L' LIC.NO.: ' -o]S"e Licensee: Signature j /Da, ,,2,1 LIC.NO.: (If applicable,enter "exempt"in the license number line) Address: /O "2 k )-}.roA) C. -E. S fl PIA b 4 a Bus.Tel.No.:'Sri��r-�3�-L1 0 el.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.L c.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 I Signature Telephone No. J PERMIT FEE: $ $j U— The Commonwealth of Massachusetts .— Department of Industrial Accidents `� V tj Office of Investigations 600 Washington Street :i 7:77 Boston, MA 02111 pax `.� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t_Vc- i y9rn,iv) & t x r Address: JCj `'Joc_ erg AD C_,-E- City/State/Zip: g'i4 -.,.,q rvt M 4a Phone #: mod'- 0..3q - z4 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with ( 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. El Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. # 9. n Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.E]L Other �� 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: --"E"'ri- )lcv r i-f O� Policy#or Self-ins.Lic.#: Expiration Date: 9 1,: tg,/, ‘:,..0 q Job Site Address: _So2.1 c 1Ucti �� City/State/Zip: )(0.rmoU h - Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the and penalties of perjury that the information provided above is true and correct. Signature: cL�,_//r 4).-teoncn-,c.--e-- Date: J J 0t ac Phone#: