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Home My WebLink AboutBLDE-22-006352 Commonwealth of Official Use Only `; Massachusetts Permit No. BADE-22-006352 �• 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:5/3/2022 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) 93 CAPT BACON RD Owner or Tenant Jason Bernardo Telephone No. Owner's Address 93 CAPT BACON RD, SOUTH YARMOUTH, MA 02664 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 ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Remodel kitchen 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 ElNo.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 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal 0 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 Siens 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Jack W Griffin Licensee: Jack W Griffin Signature LIC.NO.: 418 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:26 JOANNA DR, S YARMOUTH MA 026641339 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $75.00 OM Commonwealth of Massachusetts Official Use Only '' Department of Fires Services Permit No. lJ�— . � sN_ + Occupancy and Fee Checked %-.::4 BOARD OF FIRE PREVENTION REGULATIONS (Rev.9l05) (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 INFO ATION)' Date: 5/3/as City or Town of: S 9 Q/1ity To the Inspector of Wires: I By this application the undersigned gives notice o) his or her intention to perform the electrical work described below: Location(Street&Number) 93 C4 1 .7 cco,Q Owner or Tenant zJ CL 3 d is.J 1' /1 i)'n 1 g-C N t9€OD Telephone No. Owner's Address .5'4 - Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Services Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead El Undgrd El No.of Meters Number of Feeders and Ampacity / Location and Nature of Proposed Electrical Work: ' /1 4Gh ) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans NNDoa of TVA ormens B No.of Luminaire Outlets No.of Hot Tulis Generators KVA No.of Luminaires Swimming Pool A d. ❑ ❑ 8'*n e Battzfr.yE Uni ncy Lighthig 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. Tf� No.of Alerting Devices 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❑Municipalon Other Connecti No.of Dryers Heating Appliances KW Security yof Devices* 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 Te N ofDev�ices Egqtions iva Wiring:nt OTHER: Attached additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El ctrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE O ERAGE: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 c_29rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE z BOND❑ OTHER❑ (Specify:) I certify,under the ains and enaltie of per/ ry,that the information on this application is true and complete.,j,r1 /s y/FIRM NAME: �r r ♦ ALIC.NO.: /Y l Licensee: �7 r Signature __ LIC.NO.: 4"..o �9/� (lf applicable,elite e in the license mber li .) 'L Bus.Tel.No.: IN 117 a Sal Address: d A N 'vJz l4�/� il d Y Alt.Tel.No.: *Security System Contractor License required for thi. work,if applicable,enter 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 owner's agent Owner/Agent Signature Telephone No. PERMIT FEE:$ The Commonwealth of Massachusetts rt.!.- ey, Department of Industrial Accidents 741,Titai I 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 PERIVII ITING AUTHORITY. Applicant Information � Please Print Legibly Name(Business/Org_aniiza7 i-o-n/Ind ^ividual): � � CE /J Address: c2-6 jorN N 49 27K City/State/Zip: S �7 �t7U7 M VPhone#: Gar i-Y79 -o2J Are you an employer?Check the appropriate bo - / Type of project(required): am a employer with / emplo -. and/or part-time).* 7. construction 2.0 I am a sole proprietor or partnership and ha• no employees working for me in any capacity.[No workers'comp.insurance required.] 8. emodeiing 3. I am a homeowner doingall workmyself. 9. ❑Demolition ❑ [No workers'comp.insurance required.]t 4. I am a homeowner and will be 10 ❑Building addition ❑ hiring contractors to conduct all work on my prop'• will ensure that all contactors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-cOntraccors listed on the attach.•sheet 'these sub-contractors have employees and have workers'comp.insurance.t 13.El Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption • MOL c. 14.El Other I52,§I(4),and we have no employees.[No workers'comp.insurance -. G ) *Any applicant that checks box#1 must also fill out the section below showing•.1 workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work •.-• hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing'. name of the sub-contractors and smote whether or not those entities have employees. If the sub-contractors have employees,they must provide their comp.policy number. I am an employer that is providing workers'comperes,,•',n insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: ?3 C'A /'G d City/State/Zip:1 )QVO I/ f1/)9 e...) Attach a copy of the workers'co I, ,emotion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as -•, ed under MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00 and/or one-year imprisonme 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 •spy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the , ; a , ,,.. of perjury that the information provided above is true and correct Signature: Date: c /.//o9 oZ Phone#: z 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#: