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Home My WebLink AboutBLDE-23-004638 Commonwealth of Official Use Only Massachusetts ; • llittPermit No. BLDE-23-004638 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:2/22/2023 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 PI*. Owner's Address VACCARINO ALEXIS, 83 CUMBERLAND RD, LEOMINSTER, MA 01453-2025 ,-4.'''' Is this permit in conjunction with a building permit? Yes 0 No 0 c Appropriate x) ,;KC Purpose of Building Utility Authoriza o. 12066282 l�Lito , Existing Service 100 Amps Volts Overhead 0 Undg . 0 No.of Meters . New Service 200 Amps Volts Overhead 0 Undgr 0 No.of Me "` '- P ty Number of Feeders and Am aci Location and Nature of Proposed Electrical Work: Upgrade service&add kitchen receptacle. 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 4 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 No.of Gas Burners No.of Detection and Initiating 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 ❑ 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 VINATEA Licensee: AUGUSTO VINATEA Signature LIC.NO.: 22227 (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) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 b • E 1 � $ V Tolinmonwealth of Massachusetts Official Use Only " .4, f` 2023 23-4630 . epartment of Fire Services Permit No. '=i fft Occupancy and Fee Checked '�_'=-,- r EPl 'MRI)TO FIRE PREVENTION REGULATIONS [Rev. 11/99] ___--—__ (leave blank) By. • • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),52 CMR 12.00 Al (PLEASE PRINT INWK OR TYPE ALL INFORMATIOlV) Date: 0,z ( 1,20(27D A City or Town of: 0. ir �(1 Q U 7 To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1 (D p v 1 - YCOC nil 0 LI i , Owner or Tenant \) Q $\ I O ' c'v . G/\)e.. Telephone No. Owner's Address t k 0' ai c (\) r' v l a s.� 6 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check A Box) ai Purpose of Building , ' d G ( `Z o"‹. H rP Utility Authorization No. p Existing Service ( r)(7 Amps (2,d / L(6 Volts •Overhead®V-Undgrd 0 No.of Meters t New Service AC7 U Amps t 0Z.0 i (0 Volts Overhead a Undgrd 0 No.of Meters I Number of Feeders and Ampacity Location and Nature of Propuseil Elect 'cal Work: V E i U I` c 9C7 0 Ol' S• M.& . - k )( ^ r C 'k)X\ 0 u` Le Completion of the followinktable may be waived by the Inspector of Wires. el g No.of Recessed Fixtures No.of CeiL-Susp.(Paddle)Fans Transformers TotalA q • p P No.of Lighting Outlets No.of Hot Tubs Generators KVA No. Above ❑ In- ❑ No.of Emergency Lighting of Lighting Fixtures Swimming Pool grad. grad. Battery Units No.of Receptacle Outlets j,--/ 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. TotaTonal 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 ❑ Municipal ❑ Other i to No.of Dryers Heating Appliances KW Security of Devices or Equivalent i . ti 1A No.of Water No.of No.of o t, Heaters KW Signs Ballasts Data No.of D vices or Equivalent • t�,) 1 No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: • No.of Devices or Equivalent OTHER: Attach additional detail ifdesired 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 i undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. • CHECK ONE: INSURANCE 0 BOND ❑ OTHER 0 (Specify:) (Expiration Date) Estimated Value of Electrical Work: �` CI a (When required by municipal policy.) i T4 0 H Work to Start: t � Inspections to be requested in accordance with MEC Rule 10,and upon completion. 1 A p I certify,under thfpains and penalties Qf pperj,ury,th the information on this app 'on is true and complete. FIRM NAME: ' a V t' LIC.NO.: �tl_--A (If Licensee: �j — Signature LIC.NO. n2 --A (Ifapplicabl a e� empt"in the livens numb line. A r,� Bus.TeL No.: Address: r A I V. G v� (� Alt.TeL No.: �'G'��/f q�l�I OWNER'S SURANCE W I 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 0 owner's agent. Owner/Agent Signature Telephone No. ,PERMIT FEE:$ 41:1 Iti Li H y 0 The Commonwealth of Massachusetts ' ~ ' w--_ Department of Industrial Accidents �v , =! _ Office of Investigations "111=�i 1 Congress Street,Suite 100 ' _:!1 Boston,MA 02114-2017 .. www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly , U 4 Name(Business/Organintion/Individual): 0 .. b c CU Address: 2G 9U Q (C City/State/Zip: Q 6 h 00 VV- Phone#: 5 £7 CC'V'S/6( Are you an employer. Check the appropriate box: Type of project(required): A! I am a employer with oL 4. El I am a general contractor and I isto6. ■ 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 -4:2 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' p t3' t 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions 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.] *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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name: OntOtO ‘ i C Cu\ j c d (`(7U1Cf2._ Policy#or Self-ins.Lic.#: 1 2 53 Expiration Date: `' t (e 6( 43 Job Site Address: I l 0 C OW 4 •C a (4 City/State/Zip: 1C (� GG 1` 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 insurancc-- coverage verification. I do hereby certify under t •ppai lip penalties of perjury that the information provided a rove is ue and correct. . .� ( � Signature: t.J /` Date: Phone#: 5 C 6 7 9S/6 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#: