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Home My WebLink AboutBLDE-21-006544 t `iy Commonwealth of Official Use Only 41 I t I i Massachusetts Permit No. BLDE-21-006544 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:5/12/2021 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) 4 STRATFORD LN Owner or Tenant Bob Poxon Telephone No. Owner's Address 4 STRATFORD LN, YARMOUTH PORT, MA 02675-1545 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: Addition/kitchen Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 10 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 10 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 6 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts 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: (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: John C Burke Licensee: John C Burke Signature LIC.NO.: 50364 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:45 DIX ROAD EXT,WOBURN MA 018016104 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 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: $75.00 4 A ik iilii vg,6# n,ssAio 24 View) • • Commonwealth of Massachusetts' Official gUse Only � Department of Fires Services • =EE.i_ i Occupancy and Fee Checked =;1='= BOARD OF FIRE PREVENTION REGULATIONS • �,, (Rev-9/05) (leave blank) - _ • - APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK . All work to beperformed in accordanerwith the Massaclomron Eleeuiml Code(MEC),527 CMR 1100 . (PLEASE PRINT NINE OR TYPE ALL INFORMATION) Date: s-- //-2 1 City or Town of: WS= y/ir2r4-b.4 -. To the Inspector of Wires: III By this application the undersigned gives notice of his or her intention to petforat the electrical work described below: Location(Street&Number) Allir y _'72,Q-1 cog 1) . ... Owner or Tenant 'O l? pe) xb A/ Telephone No. i—GR- csa Owner's Address 09 *1/ is this permit in conjunction with a building permit? YesV No❑ (CheckAppropriale Box) Purpose of Building S r Nc le iCi ni r 1 y, Utility Authorization No. . Existing Services Amps _I L Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity • 4 g chi P q Location and Nature of Proposed Electrical Woric c1c ' t .' i A(, le lie", . Completion of the fallowisk table mdv,be waived by the Inspector of Wir= - No.of Recessed Ltmtiaairrs J 0 Na of Cet1-Snsg.(Paddle)Fans Traano.sfformers Total• . No.of Lmalnaire Outlets No.of HotTubs Generators KVA - Na.of Lurniooires (.71 Swimming Pool AgbruT ❑ mod- El Iii"p lyMe"c1 Lighting No.of Receptacle Outlets /v No.of Oil Burners FIRE dLA RI 1 S No.of Zones No.of Switches b No.of Gas Burners No.of Detection and Initiating Devices Na_of Ranges No.of Air Cond. Trotal No.of Alerting Devices ons No.of Waste Disposers Heatl' m Number Tons KW .. Ddtrtlon ruin Devices•• Total — No.of Dishwashers Space/AreaHeating KW Local❑Municipal ❑othrx Connection Heating Appliances KW SecurityS�•stems* No.of•Dryers Na.o[Derims orEquivaletit • No_of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.of Motors Total HP Telecommunications Wiring: No.Hpdramassage BathtubsNo.of Devices or Equivalent O1Hr.R • ' Attached additional detail lidesired eras required by the Inspector ofWtrrr Estimated Value of Wort` _ J (When required by municipal policy.) Work to Start Iaspfctions to be requested in accordance,with MEC Rule 10,and upon completion. INSURANCE 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 endersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE INSURANCES BOND 0 OTHEER❑(Specify:) I certj,tinder the pains and penalties of perjury,that the information on this application Zr true and complete. FIRM NAME: LIC.NO.: Licensee: ZO/'n/ 13i,/1% Si„gua '`, LIC.NO.: C 5 E)34.i-/ (If appEcable, in the license ember Fine) Bus.TEL No.: _� • Aarire 7 S`r`t'h p rA E y T t lN,a rat.N /yi,Q O IS d I Alr.TeL No.: �-7 -/--7 al *Security System Contractor License required for this work;if applies:Me,eater the license number here: 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 Downer's agent Owner/Agentgrgoatnre Telephone No. YERhI7P FEE:$ 7 S (10� . • Elliott, Ken From: Burke, Sheri <Sheri.Burke@childrens.harvard.edu> Sent: Thursday, August 26, 2021 8:21 AM To: Elliott, Ken Cc: John Burke; sab532@msn.com Subject: ELectrical Permits-CANCELLATION tt n i s r>r ai originates outside ofthe org anon. Ida not C nattachmentsdr�clal��nks��es are sure,this e ail is:gym a known sender and you know the content is she. Callh,the sender toverifyil if sure Otherwise;d lete e l Dear Mr. Elliott, Please cancel the electrical permits for the jobs listed below: 1.40 Benjamin Way-West Yarmouth, MA 2. 23 Scallop Road-West Yarmouth, MA Yarmouth Port,MA Thank You, John Burke Electrician License#E50364 1 _ .. - - The Commomvealth of tlfassachusetts -- . .-- ..-- Department oflrrrdusiriaXttcr dents •' '• �, —;', . i_ 1 Congress Street,Suite 100 - - • •eiI(� Boston,MAD21U-20I1 �`ei` www arssgov/dllr - . k Workers!Compensation Insurance AffidavitBoOdersiCG > �rians/Plumbets TO13E FILED Vai TFE 1 rlraserrint Le Id IicantInforntation • 14=p(Dusipmrs/OrganizatinnandividuaI): ')P-P‘/ V`�� Address: i , • • • Phone#: �s i - '7 ilk' 6-1City/State/Zip: +3 A.;e7oK as employer?Check the appreprrate bme Type of project(required): I. I era U"P loy crwith employees(full andlorpart-limn).* 7. ❑New construction - • Z m s a a sole proprietor or partnership and have no employe wedding forme in R. Remodeling any capacity.[No wodore comp-insurance required_] 9. ❑Demolition - g e wodceri comp:insurance requircl]t 3DI sari abameas+mcdein ali vrod myself[N 10❑Building addition. . tEllI am a homeowner and will be hiring contractors to condutt all work on my property.Iva 11_❑� �TzPa��additions ist a that all contractors tithes-have workers'compensation insurance Dram sole prnpnntvtS with no employees• 12.DPIumbing repairs or additions . 5.J I am a general contractor and I have hired the sob-contractors listed on the attached sheet .DRoo f repairs . These sub-umtmdnrs have=ployecs and hoc workers'camp.insurance.t 13 . ltfl er 14 • �wo area=paragon and its officers have cu�cisr.3 their afcxemptioir FOAM c. fi a wruirs'ramp.insurance required.] IQ,§1(¢],and we have no employee{[Ku • • *Any appliomtthatchee3s bozo must also Ell outthe satioo below showingtheawodas'compensation Policy information. t grimcrrwners who submit this affidavitindieet-mg @rcy am doing all work and then hire outside contractors mast submit a new affidavit indicating sad!. tCmrttactors that check this box must attached an additional sheet showing the soiree of the sub-can tractors and slate whether or not those entities have employees. If the sub conhaders have employees they mast provide their workers'comp_pnlicy •- I am rat eaTioyer drat is pravhilogivoripers,canrpensrttiLon insurance for my eo ployeer. Billow is-tire policy mid job site . irrfbrmation. - • Insurance Company Name: • ' Expiration.Date: Policy#or Self-ins.Lir, City/State: Yob Site Address: Attach a copy of the workers'compensation policy declaration page(showing th'e policy umJer and expiration date). Failure to secure coverage as required underMGL c.152,§2SA is a criminal violation punishable by a fine up to$1,500.00 • and/or one-year imprisonment;ag well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a be forwarded to the Office of7rtvcctigations of the DIA for insurance- , _ day as'=ct the violator.A copy of this statement may - coveaage verification. • Ida hereby centruder ru he v and�! ' ' •p41m Y Maitre" nrnrationpravided above is true turd correct. r Dais: C /e-y / - Signature: `� Phone#-: IIIIIV Alf `- •. tic •Iv • Official use, y Do nottrriie ut tunic near,to be mmplf4-d bp city or town oiaaL ' Pt_ruritlLir�nse# . City or Town: Issuing Authority(circle one): r LBoard of Health 2.Bulling Departo3ent 3.City/Town Clerk 4.EdecfriealInspector 5.Plumbing lnspedur 6 Otlter • • Phone*Contact Person- ' • 2fie 06 J _ 3 fc-D-e\f,