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HomeMy WebLinkAboutBLDE-22-006689 Commonwealth of (p Lc Official Use Only fit-` Asi Massachusetts Permit No. BLDE-22-006689 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:5/19/2022 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) 40 SHORE SIDE DR Owner or Tenant Flonann Maziolli Telephone No. Owner's Address 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: Remodel kitchen&bathroom. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 No.of Ceil:Susp.(Paddle)F No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot ubs \ Generators ). A No.of Luminaires Swimminll Pool Above In- ❑ No.of Emergency Lightin grnd. grn . Battery Units l No.of Receptacle Outlets 12 No.of Oil urners FIRE ALA f n /^ No.of Switches 8 No.of Gas urners No.of Det ctio IIII Initia ' vi No.of Ranges 1 No.of Air Cond. 1 N 1 o Devices A\V To,b ` No.of Waste Disposers Heat Pump Number Tons KW 1 of elf-Contained p Totals: P : •ction/Alertine Devices No.of Dishwashers 1 Space/Area Heating KW ,, al 0 Municipal 0 Other: Connection No.of Dryers 1 Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No. romassa H d a Bathtubs No.of Motors Total HP Telecommunications Wiring: y g 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:) 5.0 e—32-8`' 191+-1 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: TIAGO N RIBEIRO Licensee: Tiago N Ribeiro Signature LIC.NO.: 14640 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:5 Highland St, Milford MA 017572313 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 ❑ owner's agent. Owner/Agent Signature Telephone No. (PERMIT FEE: $75.00 -C.X.T IL941)214g---(502Atie&/t9-60e..kt ati 2.(A i-4 71\ilteitt ItAt6.4 ,,,, e (ish,e.6 6/002-ke-- c6(r2L_E__ c ... ) qvi tgets— ppo ( o qq (ft Gt r &I/ ) ... „ RECEIVED_� �j o nweanh,o f Massacluiseits Official Use Only RIM!.: MAY 18 2022 ep4trtme �7 nt o/..tire Services Permit No. (62'8Cl t_ gri.... _ Occupancy and Fee Checked —g:” ILDIBOAR �JF 1S E 'DREVENTION REGULATIONS [Rev. 1/07] (leave blank) ar — 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: 05/Q C/e2)22 City or Town of: ,IL, %o--y,w v.l'-N To the Inspector of Wires: By this application the undersigned gives notice of his or her i tention to perform the electrical work described below. Location(Street&Number) L(Q SYIO)-Cj1.l,c le Y Owner or Tenant Cic.-v o vin no-?- 9z'2,' Telephone No.5-0e- 6«7- tMg Owner's Address Is this permit in conjunction with a building permit? Yes Et No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service ,1W Amps )01,240 Volts Overhead Fl Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: _-1i QH_ �/i•r,,,�e� Lt/i Mvv+ .9✓ v►tl% 23v - -yy0c,j- Completi6 of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires , 0 No.of Ceil: Transformers KVA No.of Luminaire Outlets q No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. BatterLUnits 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. 3 Total Tons No.of Alerting Devices No.of Waste Disposers J Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers � Space/Area Heating KW Local❑ Municipal 1-1 Other Connection No.of Dryers J 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: QQ,,-� Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:,�7', t ti. 40 (When required by municipal policy.) Work to Start:V,1a1,,�,2 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 NI BOND ❑ OTHER 0 (Specify:) I certify,under the pains and pe lties of perjury,that the information on ' application is true and complete. FIRM NAME: -"\---•e..- ' I c'kto LIC.NO.: 146 4 O B • Licensee. 'a Signature LIC.NO.: (If applicabe, enter exempt"in the license number line.) Bus.Tel.No.• 5'01- _a 9y4 Address: )/✓4e/YJ Oc- n , 1 i MA 0.0.5 3 Alt.Tel.No.: *Per M.G.L. c. 147,s�61,gcurity work require epartrr ent 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 law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. Elliott, Ken From: Tiago Ribeiro <tiagoelectricalservices@gmail.com> Sent: -7riday,August 19, 2022 4:44 PM To: Elliott, Ken Subject: 40 Shoreside Dr Attention!:This email originates outside of the organization. Do not open attachments or click links unless you are sure this,email is from a known sender and you know the content is safe.Call the sender to verify if unsure. Otherwise delete this email. Good afternoon, I would like to withdraw the electric permit for the addr Please let me know if you have any questions. Thank you. Tiago Ribeiro 0 a_ Director President 1 Massapoag St, Medway (508) 328-1944 tneguev(a�hotmail.com Eike .ter......, 1 910 .91Z ? ,,_./sec--(ti--.6 q_, ' 0../(4___. /C� CcPt b r� `f�C� Njc�, yr�a'� 0 1()()140,1 ti (a re I-ec.,a_z_. V-It-e -e-i(liV��y e (pc../-1(?_..1-6./6_1---) 7-A I. ,c 9 v I .q,b_e eti -,,o,),),c --/e--L.e7„,,,eff-R.1.,r. ‘ P)71 c fle2,/ '1_4 ./7 /4 66-nE_ 02a - oD (a6$, The Commonwealth of Massachusetts "` Department of Industrial Accidents ` Office of Investigations {j Lafayette City Center - �'' 2 Avenue de Lafayette, Boston,MA 02111-1750 `,,,,.•," www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l J Please Print Legibly Name (Business/Organization/Individual): ¶ rGCC,-l'YL Co'G .�e v V i Ce/) Address: J �j V;c/)/Jc.,--(pa-- A )" City/State/Zip e w / /�102053 Phone#: 50% - g��� Cizi Are you an employer? Check the appropriate box: Type of project(required): 1.© I am a employer with S 4. ❑ I am a general contractor and I 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. El Remodeling 2.❑ I am a sole proprietor or partner-ship and have no employees These sub-contractors have 8. ElDemolition working for me in any capacity. employees and have workers' 9 El Building addition [No workers' insurance comp. insurance. comp. 10.[ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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: A,-,_ vio 1,6 V f Policy#or Self-ins. Lic.#: 0`JN li 1�2`l02 Expiration Date: c.9 /2 7/22 Job Site Address: 60 si' 0 4 c a City/State/Zip:J b(4 \fog/rya/4� )002664 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 c ify under t • , and penalties of perjug that the information provided aboveis true and correct. 4 Wass �� i�LJ�-� Date: ✓5- 0 lo� Signature: ` / Phone#: So g 32 ' --, ` tt zi 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): 10Board of Health 20 Building Department laity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0 Other Contact Person: Phone#: