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Home My WebLink AboutBLDE-23-003172 0 Commonwealth of Official Use Only itill - � Massachusetts Permit No. BLDE-23-003172 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:12/8/2022 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) 110 CAPT CHASE RD Owner or Tenant VENIOS CONSTANCE M Telephone No. Owner's Address VACCARINO ALEXIS, 83 CUMBERLAND RD, LEOMINSTER, MA 01453-2025 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 ❑ 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: Kitchen&living room Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 8 No.of Ceil:Susp.(Paddle)Fans 1 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 8 No.of Gas Burners No.of Detection and Initiatine Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton No.of Waste Disposers Heat Pump Number Tons J KW No.of Self-Contained Totals: Detection/Alertine 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 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: Augusto D Vinatea Licensee: Augusto D Vinatea Signature LIC.NO.: 527217 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:2 LINWOOD ST, HOLBROOK MA 023432029 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: $75.00 l OUGri OK 1 ZkieL' - i er*IAn/ uN6 .4 Z i34.77-/t N.�1'�� çi 7Zta' 4,&r f c 0 4611,4244A-Pi4) •elrrervi �'v un1711 �,P ) &1 2 (-Z 1 °"^'� Win. o� �o P rwa�' RECEIVED . __ m EC .0$ 2122mmo wealth of Massachusetts Official Use Only ........-z.-. ate", Permit No. Dsp- meat of Fire Services '23 '�'+; G DEPARTMENT 11 Occupancy and Fee Checked -4; -= ' -- e E PREVENTION REGULATIONS [Rev. 11/99] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 CMR i oo Cl (PLEASE PRINT iNINK OR TYPE ALL INFORMATIOII�) Date: ! < 2 R . City or Town of: ya c CY 0 k.f- To the Inspector of Wires: By this application the undersigned g notice of his or her intention to perform the electrical work described below. Location(Street&Nn er) I, 0 �0 k Nhoe k Cs c Owner or Tenant `J e r 1 G g `t 0 Z P. LA Telephone No. cor.(o uq S 16 Owner's Address a • Is this permit in conjunction with a building permit? Yes 0 No ® (Check Appropriate Box) I Purpose of Building Utility Authorization No. • G Existing Service G(j Amps `2(..../ZZ(..Volts .Overhead EY Undgrd 0 No.of Meters 1 New Service Amps / Volts Overhead 0 Undgrd❑ . No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: K '‘ - r- O - L c hrjr S -_ "r � � ` I G,\ ,_.. CA v l l c3 Cc- `^. - \ Completion of the fallowiri table g may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans 11, No.of Total 4 . 4 A Transformers KVA 0 ra p No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above 0 In- ❑ No.of Emergency Lighting brad. grad. Battery Units No.of Receptacle Outlets I a 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. Tons No.of Alerting Devices 6 Na.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 ❑ Other Connection 1,4 No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent I . Id No.of WHeaters ater KW No.of No.of Data Wiring: z g 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#fdesired or as required by the Inspector of Wires. 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 cove-.ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE i BOND ❑ OTHER 0 (Specify:) Estimated Value of Electrical Work (When required (Expiration Date)t , � by municipal policy.) I H Work to Start = Ins echo to be r uested in accordance with MEC Rule 10,and upon completion. ' 0 od A I certi under the A fy, p irs and penalties of erjury,that the information on this Itcation is true and complete. .- FIRM NAME: ., .�v.o I :% LIC.NO.: 6.1,- - I k.) Licensee: -`.J 5,e 4.z.I_'. Signature / LIC.NO.: (Ifapplicabl enter" mpt"in the license n line. Bus.TeL No.• Address: �i r' Sr �> (;_ De V Alt.TeL No.:��j OWNER'S INSURANCE WAIVER: I am aware that the Licensee oes not have the 'ability insurance coverage normally • required by law. By my signature below,I hereby waive this requirement. I am the(check one) owner's El 0 owner s agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ Iq H y The Commonwealth of Massachusetts Department of Industrial Accidents 41 Office of Investigations _l 1 Congress Street,Suite 100 =I Boston,MA 02114-2017 •°°'° www.mass.gov/dia Workers'CompensationlInsurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): t.1 p)&.Q —U C Address: i (/ City/State/Zip: t\,(`, \ b C-Cr Up Phone#: ( G ci Q( S (' 1 Are you an employer?Check the appropriate box: Type of project(required): 1. e am a employer with ' _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.11 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *My applicant that checks box#1 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: "'J�• U Q./ 6 ° • Av�.C� Policy#or Self-ins.Lic.#: Expiration Date: 1, . I�3 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 insuran e coy ge verification. I do hereby certift under the p s n Ities of perjury that the information provided above is tr and correct. Si ature: Date: L 2 2_2 Phone#: —''5cC (-RS C 1 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#: