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Home My WebLink AboutBLDE-22-002849 Commonwealth of Official Use Only _ ., 4) Massachusetts Permit No. BLDE-22-002849 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:11/17/2021 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 OLD CASTLE RD Owner or Tenant LYONS CAROLYN COX Telephone No. Owner's Address C/O 0,''?^' YN L Rf f N ENE PLEASANT STREET COURT, CHARLESTOWN, MA 02129 Is this permit in conjunction w" a building pert tft? 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 basement 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 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: MICHAEL S SOBY Licensee: MICHAEL S SOBY Signature LIC.NO.: 10097 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 Lake Dr,Orleans MA 02653 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: $75.00 004,(A54 << A)(2.1 f. Ai f`_,( I Commonwealth o/!/la3sachu.e(L4 Official Use Only 1► t 2)eparlmenl o� lire�ervice3 Permit No. C�Z� 7---- !f @y Occupancy and Fee Checked .,:- '' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( EC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: (( 1(e i 1-1 City or Town of: A( To the Inspector of Wires: By this application the undersigned : yes notice of his or her intention to perform the electrical work described below. Location(Street&Number) •„-, `o ,;.:;�,'rt ,,c.4 d(d carykt. 2d Owner or Tenant Caro( A SeAr-fn f Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No.- (Check Appropriate Box) Purpose of Building S it f p_freur�,��5 ,,el.e,1.(�Q� Utility Authorization No, Existing Service mps 0 / Volts Overhead C Undgrd ❑ No.of Meters New Service Amps / Volts Overhead C Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: €Ci Air p / 60.77 nat.) ' , ' ,02(1/t.S4d eacmp.th-- 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:pf 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 Li No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.rof Ranges No.of Air Cond. Total No.o f AlertingDevices 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 cal❑ Municipal Connection ❑ Lo Other `No.)pf Dryers Heating Appliances KW Security Systems:* No.of tevices 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: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: '16t 000 (When required by municipal policy.) Work to Start: I(i f6/�' Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C V RAGE: 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 ® BOND ❑ OTHER 0 (Specify:) I ceri'tfy,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Soby One Home Services LLC LIC.NO.: 10097B Licensee: Michael Soby Signature "`Z- - s LIC.NO.: 10097B (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:633-762-9663 Address: 9 New Venture Dr.Unit 4,South Dennis,MA 02660 Alt.Tel.No.: 774-216-0935 *Per M.G.L. c. 147,s.57-61,security work requires Department 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)❑owner ❑owner's agent. Owner/Agent 611 Signature Telephone No. PERMIT FEE: $ i� i l `• The Commonwealth of Massachusetts ="= Department of Industrial Accidents ; Office of Investigations _71= 600 Washington Street • _� Boston,MA 02111 WWW.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly • Name(Business/Organization/Individual): °Soby One Home Services LLC • Address: 9 New Venture Dr.Unit 4 City/State/Zip: South Dennis,MA 02660 Phone #: 774-216-0935 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with V 4. ❑ I am a general contractor and I have hired the sub-contractors employees(full and/or part-time).* 6. New construction listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.f 9. AI uiiding addition required.] 5. ❑ We are a corporation and its 10.Fe lectrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work 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' 13.0 Other comp.insurance required.) 'Any applicant that checks box NI 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. tContractors 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. lithe 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:AIM Mutual Policy#or Self:ins.Lie.#: WCC50050242272021A Expiration Date: January 25,2022 Job Site Address: v l 6 j4 0,04 ed City/State/Zip: f n'�YQ',�2(or( p v Attach a copy of the workers'compensation policy declaration page(showing the policy ber and expiration date). Failure to secure coverage as required under Section 25A of MGI,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 cert under the pains and penalties of perjury that the information provided above is true and correct. Signature: "`2-7 3- Ulf J Date: f. Phone#: 774-216-0935 f 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): ' I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: • Phone#: