HomeMy WebLinkAboutBLDE-23-002167 OF tzt, Commonwealth of official Use Only
'IL, ` Massachusetts Permit No. BLDE-23-002167
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)
City or Town of: YARMOUTH Date: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) 34 LYNDALE RD
Owner or Tenant KEN ELTOTE
Owner's Address Telephone No.
Is this permit in conjunction with a building permit? Yes 0 No 0
Purpose of Building (Checic„�i rapt' ox)
Utility Authorization No. (i ' '( 7�t 2- 1
Existing Service Amps Volts Overhead 0 Undgrd 0
New Service VoltsgNo.of Meters
200 Amps Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity =•> �,
Location and Nature of Proposed Electrical Work: New residence(Pre-Fab)
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
No.of Luminaire Outlets Transformer§ i# KVA
No.of Hot Tubs Generators '',, ,r-;(VA
No,of Luminaires Swimming Pool Above ❑ grnd. ❑ No,of Emer•gency Lighting..
rnd. Battery Units ,
No,of Receptacle Outlets No.of Oil Burners FIRE ALARMS INn.of Zones
No,of Switches No.of Gas Burners No.of Detection and
Initiative Devices
No,of Ranges No.of Air Cond. Total
Ton No.of Alerting Devices
No.of Waste Disposers Heat Pump I Number I Tons 1 KW No.of Self-Contained
Totals:
Detection/Alertme Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal
Connection 0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No.of No,of Devices or Eauivalent
Heaters KW Sims No.of Ballasts Data Wiring:
No.of Devices or Eauivalent
No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
OTHER No,of Devices or Eauivalent
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work:
Work to start: (When required by municipal policy.)
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
:)
I certify, fperjury,under the pains and penalties othat the information on this application istrue and complete.
FIRM NAME: Michael E Praino
Licensee: Michael E Praino
Signature Tel. NO.: 27321
(If applicable,enter"exempt"in the license number line.)
Address: 16 UNION ST,W BRIDGEWATER MA 023791822 Bus.Tel.No.:
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:$180.00
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7] n Permit No, E-7•3,—I ��
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>�— Occupancy and Fee Checked
=` " BOARD OF FIRE PRFVENTIONREGULATIONS
[Rev. I/07] (leave blank)
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 INFOXATIO.A9 Date: (2c f
�'� ` Z G/dv�-
City or Town of:
/g�-m a Gr To the Inspector o f(Wires:
By this application the undersigned gives notice/ of is or her intention to perform the electrical work described below.
Location(Street&Number) 3/ ,/y 4 'f, i7D
Owner or Tenant :/CeA/ '[�'/:1
', Telephone No.
Owner's Address -S? 7 r 4j,✓.
Is this permit in conjunction with a boil
�/ g permit? Yes � No 0 (Check Appropriat ox
Purpose of Building i PJ/k :.i Utility Authorization No. ✓`d 15 r
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
New Service ?-a, Amps /2 / 27 Volts Overhead 0 Undgrd 0 No.of Meters /
Number of Feeders and Arnpacity
Location and Nature of Proposed Electrical Work: �' 4e e
,96 f Pi-- C4l 'e a/ >4 ,C1 ,'-c-f
Completion(tithe following table may be waived by the inspector of Wires.
No.of Recessed Luminaires No.of Coil.-Soap.(Paddle)Fans ge.of TotaAl
m Transforers
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
No.of Luminaires Swimming Pool Above ❑ fa- No.of Emergency Lighting
grad, grad. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS !No.of Zones
No.of Switches No.of Gas Burners No.ot`Uetectiou and
Initiating Devices •
No.of Ranges No.of Air Cond. .• onsl No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons W No.oj`Sel#Gontainecl
L Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local❑ Municipal
Connection 0 morel•
No.of Dryers heating Appliances iry Security Systems:*
No.of Water No.of No.of Devices or Equivalent
• K' No.of Data Wiring:
Signs Ballasts No.of Devices or Eglnivalent
No.Hydromiassage Bathtubs No.of Motors Total HP Telecommunications Wiring:
No.of Devices or Equivalent
OTHER:
Attach additional detail iifdesired,or as required by the Inspector of Wires
Estimated Value of Electrical Work: C/I, (When required by municipal policy.)
Work to Start:OCf l/ 2C,2Z- 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 0 BOND 0 OTHER ❑ (Specify:)
I cert/,under the pains and penalties o perry,that the information on this application is true and complete.
FIRM NAME: o/GAi �if////l/✓& , ,
i(-,l e.7 , Signature - LIC.NO.: 7 ��..
Licensee: �f�/f%/1i[i
(fapplicabl��to xempt"%n the llcens�l gr� LIC.NO.:
Address: /71rG/L 1 { `ne) ' Bus.Tel No.: i on ��'
*per M.G.L.c. 147,s.57-61,security work requirea'Depar e Public it SafetyAlt.Tel.Na.:Ste'
OWNER'S INSURANCE WAIVER: I am aware that the Licensee doeshot have the liabilitytan No.
required by law. By my signature below,I hereby waive this requirement. I am the(check one insurance coverage normally
Owner/Agent ❑owner ■ owner's a eat,
Signature Telephone No.
The Commonwealth of Massachusetts
—.� �rl Department of Industrial Accidents
Sa ! r Office of Investigations
tA, '{... Lafayette City Center
` o,
www.mass gov/dia 2Avenue de Lafayette, Boston,MA 02111-
1750
Workers'Compensation Insurance Affidavit: Builders/Contra
A lican .Inform 'on Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual): Please Print Le ibl
Address: g • r _
City/State/Zip:1� S�. _ *.
— — _.r _ Phone#:
Are you an employer?Check the ,ppropriate box:
1•0 I am a employer with 4, [� 1 am — -.__._ .
a genera) contractor and I Type of project(required):
employees(fill and/or part-time).* have hired the sub-contractors 0 New construction
21 am a sole proprietor or partner- listed on the attached ship and have no employees These sub-contractor have 7.
Remodeling
working for me in any capacity. employees and have workers' 8. Q Demolition
[Na worlcels' camp. insurance comp. insurance.:
9. 0 Building addition
required.] S. 0 We are a corporation and its 10.El Electrical repairs or
3•❑ 1 am a homeowner doing alI work officers have exercised their
myself. p additions
[No workers' comp, right of exemption per MGL 11.0Plumbing repairs or additions
insurance required] t c. 152, §1(4),and we have no 12• Roof repairs
employees, [No workers' 13.0 Other
comp. insurance*Any applicant that checks box#1 must also Ill out the section below showing their workers'compensation
t homeowners who submit this affidavit indicating they am doing all work and then him outside con
tConmeown that cheek i box must affidavit
indicating
an oddity a doing all wok the namen ihe subcontract contractors
mustoey information.
a new such.
employees. If the pek this
sub-contractors have Cachedernployees,a theyd must sheprovide showing
of
y trttctoran submit a new affidavit►ndities haveg such.
workers'1. ors and state whether or not those entities
ham an employer that is providing workers'compensation insurance for my employees.r�fr�d umBelow is the policy and job site
Insurance Company Name:
Policy#or Self-ins.Lic.#:
Job Site Address: Expiration Date:
Attach a copy a#'the workers' compensation policy declaration City/State/Zip:
Failure to secure coverage as required under Section 25A of MGL c. policyPage(showing the imposition number and criminal expiration date}
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form
p to $1,5 0 a day o the violator. Be advised the 152 can lead to faSP WORK ORDER and of a
Investigations of the DIA for insurance coverage verification.co of a STOP h and a fine
copy of this statement may be forwarded to the Office of
I do hereby cert6 under tl
pains an penalties of perjury that the information provided above is true and corn
Si nature:
ect.
P ne# d r _ Date: 0 :fie �G ,2
Official use only. Do not write in this area to be co
mptcted by sty or town official
City or Town:
Issuing Authori Permit/License#
1�Board ofHealthheCl�one):
Inspector 6. �Bailding Department 30City/To�yn Clerk 4,0Electrical Insoctet 5
[]Outer
Contact Person: p "jumbing
Phone#:
Commonwealth of Official Use Only
k f Massachusetts Permit No. BLDE-23-002167
BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked
[Rev.l/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:10/24/2022
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) 34 LYNDALE RD
Owner or Tenant KEN ELTOTE
Owner's Address Telephone No.
Is this permit in conjunction with a building permit? Yes 0 No 0 (Checl, rope ox) --7
Purpose of Building Utility Authorization No :�� (( 7 t 9' ,Z (
Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters
New Service gw �`
=r
200 Amps Volts Overhead 0 Undgrd 0 No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: New residence(Pre-Fab)
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 f KVA
No.of Luminaire Outlets No.of Hot Tubs
Generators VA
No.of Luminaires Swimming Pool e 0 grnd ❑ No.of Emergency Lighting
Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS 1No.of Zones
No.of Detection and
No.of Switches No.of Gas Burners "
Initiating_Devices
No.of Ranges No.of Air Cond. Total No.of AlertingDevices
Ton
No.of Waste Disposers Heat Pump I Number l Tons 1 KW No.of Self-Contained )
Totals: Detection/Alertine Devices
No.of Dishwashers Space/Area Heating KW Municipal Local 0 Connection
0 Other:
No.of Dryers Heating Appliances KW Security Systems:*
No.of Water No,of Devices or Equivalent
KW No.of No.of Ballasts Data Wiring:
Heaters Signs He.te dromassa a Bathtubs ,LS'o.of Devices or Equivalent
y g 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
I certify,under the pains and penalties o e u that the information on this application is true and complete.
fP ►7 +Y,
FIRM NAME: Michael E Praino
Licensee: Michael E Praino Signature
LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 27321
Address: 16 UNION ST,W BRIDGEWATER MA 023791822 Bus.Tel.No.:
*Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.;
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: $180.00
►`C134 ik,)'' ` !1'�ti7/iM`t 3 /4( Z72 1' .
SP(l is l CC (c( .(23 (-
Continonwea
.oi//laesac s(fe Official Use Only
i• 1;0 ,tPernut No,
• , -'21_
(4. (
"` REGULATIONS BOARD OF FIRE PREVENTION REG Occupancy and Fee Checked
[Rev. 1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MIIC),527 CMR 12.00
(PLEASE PRINT INMKORTYPE ALL INFOpdATIOJv) Date: (,2c 7`1,..f✓,. i i
City or Town of: ,5,/fL./yjar l( To the Inspector of Wires:
By this application the undersigned gives notice of is or her intention to perform the electrical work described below.
Location(Street&Number) .,S/ Z 1 1 e / W
Owner or Tenant it-tw C - j Telephone No.
Owner's Address
^
Is this permit in conjunction with a buildlfig permit? Yes Er No El (Check Appropria ox
Purpose of Building AP_J/,/ Utility Authorization No. ,/d r
Existing Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters
New Service t Amps /( / 27 Volts Overhead El Undgrd❑ No.of Meters /
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: le me ,4,, ,e /'- `�4,je-
P1' �4Pi (//#e(h' >4 ,("0l7 c ,/7�`
Completion ofthefollowlag fable may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of CeiLTransformers
-Soap.(Paddle)Fans No.of KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KYA
No.of Luminaires Swimming Pool Above In- No.of Lcmergency Lighting
god. grad. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS ?No.of Zones t
No.of Switches No.of Gas Burners No.of Detection aiii
Initiating Devices
No.of Ranges No.of Air Cond. Toms Tons No.of Alerting Devices
No.of Waste Disposers Meat Pump Number 'Cons 1(CW Na of Self-Contained
Totals:1". """" """""" - Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local Municipal
Connection ❑ '
No.of Dryers Heating Appliances KW .ueeurity Systems:*
No.of Water "No.of No.of Devices or Equivalent
No.of
KW Data Wiring:
Heaters
Signs Ballasts No.of Devices or Eq iivalent
.No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wising
OTHER:
No.of Devices or Equivalent
Estimated Value of Electrical Work: Attach C/p, additional detail lfdestred,or as req
uired by the Inspector of Wires.
(Whenrequired by municipal policy.)
Work to Start:&CF).jj 26,7Z 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 0 BOND 0 OTHER ❑ (Specify:)
I certl,under the pains and penalties o p ry,that the information on this application is true and complete
FIRM NAME: �I/Cdl�e/ / .-
. LIC.NO.: 7 ��
Licensee: "cf7,yi''7 tagtjpG Signature
a applicable, ter"excerpt"fn,fie Ileenfe r:unger LIC.NO.:
Address: a _ j� %�.} 1
Boa.Tel.No. �iU —� 44>
*Per M,a.T.c. 147,s.57-61,security work mu' De ---- Alt Tel.No.:Sr'
License: Lic.No.
OWNER'S INSURANCE WAIVER: I am aware that Mare Liicenseeudoes not have the liability insurance coverage normal)
required by law. By my signature below,I hereby waive this requirement. I am the(check one owner Y
Owner/Agent A owner s wont.
Signature Telephone No.
.t'ERMI?FEE: $