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Home My WebLink AboutBLDE-22-005253 . \lidi Commonwealth of Official Use Only 41 I1%, Nil ' Massachusetts Permit No. BLDE-22-005253 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:3/21/2022 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) 18 LYNDALE RD • Owner or Tenant EGAN JAMES M Telephone No. Owner's Address EGAN TINA, 78 HUNT DR, STOUGHTON, MA 02072 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Ap Qpna Ox) Purpose of Building Utility Authorization No. '�� Existing Service Amps Volts Overhead 0 Undgrd 0 , e No`of Meters °' ) r,� New Service Amps Volts Overhead 0 -Undgrd 0 `"`...No of Meters ' '"`� Number of Feeders and Ampacity / � �y Location and Nature of Proposed Electrical Work: New bedroom,2 bath roof is, Hot tub, lights in 2 bedrooms " ,r' F ''' m on of the following table �a' d �yyInspec . of Wires. Tota ' No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle) No.of Fans Transformers 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 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 Signs 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: 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 ' RECEIVED MAR 18 2022 Coin onwealth of Massachusetts Official/� Use Only BUIL PARTMENT permit No. vi ,5Sn'3 BY -y =t__ ' = rtment of Fires Services ti Occupancy and Fee Checked i� ,,, BOARD OF FIRE PREVENTION REGULATIONS (Rev.9105) (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M ¶'7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO ATION) Date: .?/7�a a City or Town of: S %J"Ft(!IIOf1 To the Inspector of Wires: I By this application the undersigned gives notice f his or her intention to perform the electrical work described below: /Location(Street&Number) 7 C4 Owner or Tenant T KO 7 7J�4 9A ) Telephone No. Owner's Address Is this permit in conjunction wit,Fi a building permit? Yes❑ No ❑ (Check Appropriate Box) Purpose of Building / I Am/hi 4a u.s-Jr._) Utility Authorization No. Existing Services Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty /� � Location and Nature of Proposed Electrical Work: A/FW iene,-00M J .2 Bpr'/I IY1Sj / /7J•/1 74 /IOL) It.Jf Po oZ eel gmms Old tvowk 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 f Total Transformers No.of Lumminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Agrad.bove ❑ grad In- NNo. . r❑ of 3 EUni cy Lighting 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 Tofu KW No.of Self-Contained t Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal Other No.of Dryers•ers Heating Appliances KW Security Systems:' No.of Devices or Equivalent No.of Wa KW No.of No. DgNo Wiring: ffDDeviices or Equivalent Heaters No.of Motors Total HP Telecommunications Wiring: No.Hydromassage Bathtubs No.of Devices or Equivalent OTHER: Attached additional detail if desired,or as required by the Inspector of Hires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:3 7 9-a 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 cov age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE AI BOND 0 OTHER❑ (Specify:) I certify,under the p arulpenalties4Rerjury,that the information on this application is true and complete. p FIRM NAME: �1 a- �j6ra tTJ� LIC.NO. � 7�o ZJr Licensee:' ' Gi 111 A Signature LIC.NO.�as9Q/9�j / (If applicable,en r' pt"in the license tuber line.) ��/ Bus.Tel.No.: 97� Y? 0`SJ( Address: e9 oAtr4A �lC yiiK 0041 )q I!(pwy Alt.Tel.No.: 'Security System Contractor License required for this 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 ►" 51 _!� Department of Industrial Accidents t "' Congress,Street, Suite 100 4.%1"" � Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMI I'I'LNG AUTHORITY. Applicant Information f� Please Print Legibly Name(Business/Organization/Individual): Address: . 02 „LAP-wig Dic CityIState/Zip:�c fi4C/)7#t4 M 14 oa, 'r Phone#: g7Y" 79"(72- g/ Are you an employer?Cheek the appropriate box: Type of project(required): I.dam a employer with / empl• .0 • or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[Na workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself[No workers'comp.insurance ,. •.]t 9. El Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my ,•.. . I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or: sole I I.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the ors listed on. attached sheep These sub-contractors have employees and have workers'comp.ins ! 13.El Roof repairs 6.0 We are a corporation and its officers have exercised their right of a • .., per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'camp.;. I required.] *Any applicant that checks box#1 must also fill out the section below ; :their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing: . and then hire outside contractors must submit anew affidavit indicating such. I-Contractors that check this box must attached an additional sheet-•owing the name of the sub-aonfraon:1is and state whether or not those entities have employees. If the sub-contractors have employees,they must•,• • their workers'comp.policy number. I am an employer that is providing workers'co• r,ensation 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: /8— 0.6 jVa4 City/staterzip5 cf A'cAT°S fit fl Azi4 t/ Attach a copy of the work 'co, pensation 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 imprisonmen = well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A •y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify , : d penalties of perjury that the information provided above is true and correct Sisnature: Date: c3//!`"9 - 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#: