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Home My WebLink AboutBLDE-22-003224 P44\ �(?) Commonwealth of Official Use Only "LTAMassachusetts Permit No. BLDE-22-003224 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:12R/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) 24 LITTLE DIPPER LN Owner or Tenant KILMARTIN HUGH TRS Telephone No. Owner's Address KILMARTIN S&SAICH E&P TRS,4 KENTS LN, HINGHAM, MA 02043 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: New bedroom, bathroom&3 season room. Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires 18 No.of Ceil:Susp.(Paddle)Fans 1 Transformers KVA No.of Luminaire Outlets 4 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 30 No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches 13 No.of Gas Burners Initiatine Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Ton Heat Pump Number Tons KW No.of Self-Contained 5 No.of Waste Disposers Totals: 3 3 6.8 Detection/Alertine Devices al Munici No.of Dishwashers Space/Area Heating KW Local 0 Connection 0 Other: Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: 2 Heaters Siens No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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.) y' 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: Louis T Bonitto LIC.NO.: 23056 Licensee: Louis T Bonitto Signature (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 13 WELLFIELD RD, FORESTDALE MA 026441613 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. I PERMIT FEE: $75.00 ( 04ti I(ill - -�1tt1A ' . . RECEIVED &, DEC 0 6 num, “ah 4 Maddadiuddid Official Use Only Permit No. ti, qt., ,.... \,) .' ap, .%U I L DI NG DE PA Radirycnieni 4.7ire Serviced •.. ,: .0,y Occupancy and Fee Checked . .• ..* 44 -OARD OF FIRE I-1KEVENTION REGULATIONS tRev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Not, All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 IP' (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1-4-, -3--.a- ( City or Town of: Yetrin 0 t7t1I To the Inspector of Wires: \I By this application the undersigned gives notice of his or her intention to perform the electrical work described below. ill .... Location(Street&Number) 'D q Lt-fi 1 - ---qt- per 1...,,,-e— Owner or Tenant i-kjAVk 4 5 0..,:-..coA -Ki cri.../-1-/h Telephone No. Owner's Address .'4- Lrftie_ 1),pp-et- tve_ I S-- , Xtrivkloah Is this permit In conjunction with a buildingpermit' Yes LA.: . No Lj (Check Appropriate Box) Purpose of Building-Re_w cl M cUi-h ON Utility Authorization No. -11 Existing Service to Amps 1 31.)/ 3‘-it Volts Overhead P. Undgrd 0 No.of Meters / -.-Z New Service iiiii Amps / Volts Overhead 0 Undgrd 0 No.of Meters lio Number of Feeders and Ampacity IN A _4 Location and Nature of Proposed Electrical Work: N„AL, Bedroom i i &di 1 rdayi/356,1,104 eciailt , 'II Completion of the following fable may be waived by the Inspector of Wires. v• a No.of „r‘ Total t..t; No.of Recessed Luminaires i e, No.of Ceil.-Snap.(Paddle)Fans j Transformers Li KVA cni c) No.of Luminaire Outlets NI A No.of Hot Tubs 0 Generators 0 KVA <A, k No.of Luminaires ii Swimming Pool Above-v-1 In- z•N 1--, No.of Emergency Lighting 0 grad.k-A-I wild} " Battery Units '...;:t No.of Receptacle Outlets 3Q No.of Oil Burners 0 FIRE ALARMS No.of Zones 0 •-•,. No.of Detection and No.of Switches 13 No.of Gas Burners 0 Initiating Devices 0 11.1 No.of Ranges D No.of Air Cond. 0 Trains No.of Alerting Devices 0 (--, Rest Pump Number Tons KW No.of Self-Contained No.of Waste Disposers ....5 t.." Totals: .3 IC a' Detection/Akrtingpevices No.of Dishwashers C.) Space/Area Heating KW 0 t ci Local 0 launnaticPtiaoln 0 Other N A. 0 Heating Appliances D KW Security Systems:* No.of Dryers No.of Devices or Equivalent htli No.of Water No.ofNo.of Data Wiring: Heaters 0 KW p Signs Li Ballasts No.of Devices or Equivalent ,P‘ Telecommunications Wiring: No.Hydromassage Bathtubs 0 No.of Motors 0 Total HP No.of Devices or Equivalent 0 OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When requited by municipal policy.) Work to Start: a-7 - )4 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 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: L-(20 j-S 7,- Bop clic) sJi-. LIC.NO.:g3a111-E ____...- . •--- Licensee: Sci.me.- Signature :;-:"„,.. L.,.! LIC.NO.: (If applicable,enter"exemptrip.the iicetse nor*linsj., ,,,, 7. id Bus.Tel.No.: 01 7-gi...4— Address: i 3 We-let/el Ka1.i-tDreSt t i IAD'.b T 7 Alt Tel No.: —C14- AI A - *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally required by law. By m signature below , by waive this reciuirement. I am the(check one) owner 0 owner's agent. Owner/Agen• Signature i.., Telephone No./g1-We yeDS- PERMIT FEE:$ The Commonwealth of Massachusetts --.�'il li= Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 — "• www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): t_-00 "/— Address: � d p Ci /State/Zi fic Phone• 7 P' � �� #: (p C ( - 403 /1093 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 2. 1 am a sole proprietor or partnership and have no employees working for me in 7. [I]NTew construction 8. R any capacity.[No workers'comp.insurance required.] emodeling 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will I O ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.1gElectrical repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.: 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14•❑Other 152,§1(4),and we have no 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. r 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: Policy#or Self-ins.Lic.#: Expiration Date: Job 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 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 pains and penalties of perjury that the information provided above is true and correct. Signature: , s ! Date: 47— —0Z./ 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(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: