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Home My WebLink AboutBLDE-22-002202 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-002202 i0BOARD 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:10/18/2021 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) 28 WINDJAMMER LN Owner or Tenant CHANDLER DAVID H Telephone No. Owner's Address BLOME KAREN J,28 WINDJAMMER LN, 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 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: Install receptacle for fire place blower. 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 1 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.Init of at DetDevices andection No.of Ranges No.of Air Cond. Tons Tota 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* y No.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters .Siens 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 ❑ 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: KEVIN A CRONIN Licensee: Kevin A Cronin Signature LIC.NO.: 11275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:238 SHERI LN, S WEYMOUTH MA 021901254 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: $50.00 cIO/221"24l4/ - , RECEIVED .- A 0 CrT i S 2021 , , - 0/Massaclassaits Official Use Only P e r m i t N o. ' Z5/ 2:2-E)c--1-• P ,-,--DE—RTME 3 . 4.7i,.S.. ... - - , j;uh.G DEPARTME -. . —— Occupancy and Fee Checked -:17--i-ir - PREVENTION REGULATIONS (Rev.1/071 1/4‘ (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in acconhmce with the Massachusetts Electrical Code(MEC), 27 7ft 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: /7;) /cr. , City or Town of: gives AI al -NI- To the Inspect r of Wires: By this application the undersigned notice of his or ... intention to perform the electrical work described below. , @) Location(Street&Number) D/00 Wi A o./..) = • E Owner or Tenant A. A P 2/.//2_ Telephone No.41/3 ,c32 i3 3_1 • ."3, v 4.) Owner's Address ('.,, ij/n Ji4 h44 cy tki_ SS)/Aviii L97----AL"4 0.‘ 0 e3.10 5/ =In . Is this permit in conjunctionAlth a buNZL,permit? Yes 0 No Er (Check Appropriate Box) 2 w Purpose of Building 0 6e--3 / Utility Authorization No. Tv' 44, u — Existing Service / dAmps (2e../ )y Volts Overhead El-----lindgrd 0 No.of Meters/ ru 0 Y New Service Amin / Volts Overhead El Undgrd 0 No.of Meters Number of Feeders and Ampadty Al AL Location and Nature of Proposed Electriad Work: / //t,) e I. ECT/I k pi, . 0 A/C-: ., a 0 GU cell< aq Ther GIZ '6-ft?f/ C---.= G.4CE- g(V14,6 4-. kr, Cowie&n ofthe following tabk way be waived by the hatitector of Wires. o.of Total i.,1,1 No.of Recessed Luminaires No.of Ceil.-Stesp.(Padde)Fans Transformers KVA No.of Luke Outlets No.of Hot Tubs Generators KVA c, Above 4 rn In- rn No.of linsergency Lighting No.of buninaires Elvhsating Pool grad. 1--I nod. Li Battery Units No.of Receptacle Outlets ) No.of ON Burners FIRE ALARMS No.elbows c No.of Switches No.of Gas Burners PhTo.of Detection and hdlintina Devices Tani ' No.of Ranges No.of Air Con& Tons 4141o.of Akrling Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerthm Devices No.of Dishwashers Space/Area Heating KW Local 0 Mulliconneetn 0 Other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs %Rests Na.of Devices or lecost Equivalent mendattions No.Hydromassage Bathtubs No.of Motors Total HP Te No.of Devices or Eq t OTHER: Attach adtiltional detail yiksire4 or as required by the Inspector of Wires. Estimated Value of Electfical Work: 4/-C..0 (When required by municipal policy.) Work to Start /0/ 7)/ 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 Z BOND 0 OTHER 0 (SPecifT) I certify;under the pains and. , ,,.'.. ofpesissiy,that the information on this application is true and complete. FIRM NAME: Kevin A Cronin-Electrician , KIIIGkerianin—Electrician 7 Liefs Lane , i 2AL, LIC.littiefs Lane Licensee: ifj• I . r• II ionf' Of affilicabk,enter"exempt"itt. M 7 '.'" '.' _812 5,57c snag*Kelynouth , MA 02664 Address: • - .., AlliCte121t6A. P.781-812-557L *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,thereby waive this requirement I am the(check one)0 owner 0 owner's agent Owner/Agent Signature Telephone No. I PERMIT FEE:$ The Commonwealth of Massachusetts Ia c/ u of.lndlA�t4 ; 1 Congress Stree Suite 100 Boston,MA 02114-2017 Workers'Compensation Insurance r gofYdla ranee Affidavrti lumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ame Please Print Leaibl~y. Kravin A mnin Icu ldan Address: 7 Liefs Lane South Yarmouth , MA 02664 C. • CitylStat+elZip: ' Phone#: Are you as employer?Check the appropriate box: I. I mo a w implores Eft ahhdlor part-time).* Type of project(required): ?gl am a sole proprietor orpaveno 7- New any may.Rioempl workers'conga insurance ]working for me in 8. El Remodeling construction 9. 0 Demolition 3.E1 I am a homeowner doing allwork myself[No wow,comp-insurance required.]t 4 I a n a and will be to all w rkon 10 $addition - ensure that�eentrae�enrs eitherhave workers' �prey- l wdI props with no employees. or are soy I I. Electrical repairs or 5.0I am a> eantratsor and I have red the listed on the attached sheet l2 Plim t� O1 additives These�s have employees and have workers'comp.instranc e t 13.Q Roof repairs 6.0 wewea and officers have exercise' their ' I4. tamer $�$I{4I a on have no per 1wIGI.c .[No vrcrloers'comp;uhh aril nat checks box i�what size this#1 must also fill out the section blow shovrag their a�orloers' policy infiamorin Fka rectors that check this box must cating they are doing all work and then hue outside eootractoas most submita newn ffidavit indicating stack hoat showing the name of the employees. If the pie theme warlass'cam..policy number.and state whether not those entities I formation. �&P g workers'compensation insur for my employees. Below is the am an policy and job site Insurance Company Name: Policy#or .Lie.#: Expiration Date: Job Site Adckess: Attach a copy of the workers'cons City/State/Bp:policy dedaration page(showing the policy number and expiration date). Failure to serve coverage as required under MGL c. 152,§25A is a criminal and/or�� as well as civilviolation�k by a fine up to$1,500.00 day against the violator.A copy of this sta#��in the form of a STOP WORK ORDER and a fine of up to$250.00 a coverage verification. �` to the Officeof Ia of the DIA for insurance I doF f the and *perjury thatthe ifr} a foie and correct S • i . : evin A Cronin-Electrician d Date Phone#: South Yarmouth , MA 02664 Official:meonly. Do ftotwritj this area4 to be compbzted bydtyortown offidal City or Town: Issuing Autho ' ci P °� my( rt:k one): I.Board of Health 2.Bending Department 3.City/Town Clerk 4. 6.Other C Eledrical Inspeetor Phtntl>ing Inspector Contact Person: Phone#: