No preview available
HomeMy WebLinkAboutBLDE-22-000405 Commonwealth of Official Use Only �. Massachusetts Permit No. SLOE-22-000405 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:7/22/2021 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) 4 GLENWOOD ST Owner or Tenant Ocean Vacations, LLC Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Finish wiring of furnace, hot tub, &second floor bathroom. (Rough done by others) 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 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 Tons 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 0 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 Stens 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: ANDREW M LEVESQUE Licensee: Andrew M Levesque Signature LIC.NO.: 17318 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:461 LOWER COUNTY RD, HARWICH PORT MA 026461831 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: $250.00 Ler AA$s c 0/2/,2+ /:h.) kV' 029SVEji eAD 5Cvut'r D•vr ►user Nor-%�1 . . Commonwealth o/Mateachunetta Official Use Only /� 1 4=_ /, n cc77 Pennit No. r�q-Z,--ID 6 = _ dJePartmznt o1 ire Ser>u. Occupancy and Fee Checked f. _e BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PER 8T TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: rl 2.o 2 c G City or Town of: ed.A-R L ti 1-E-4 To the Ins Actor f Wires: By this application the undersigngives notice of his or her intention to perform the electricaltc work described below.p Location(Street&Number) I �N V ` G lj STKie E T V VIES f ykK/v t U v n t�1-4 Owner or Tenant Cj CAN \/k l 6 N (,L. Telephone o. Owner's Address Is this permit in conjunction� � withp a building permit? Yes l—I I No L (Check Appropriate i1 ox) Purpose of Building 1�-r�S'(. NI C.I Utility Authorization No. Existing Service Amps / Volts Overhead Undgrd[I No.of Meters New Service Amps / Volts Overhead L, Undgrd No.of Meters Number of Feeders and Ampacity pp ��f rr (_ �r Locationo and Nature of Proposed Electrical Work: 1 N K V` I R 11'*7 O - I v ` ititi� KN[ U�rSfk6 S f rk — �i v -r-f' Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil: p•(Paddle FansT of) Transformers KVAVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires swimmingpool 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 Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other i No.of Dryers Heating Appliances KW Security Systems:* rY No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa 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 Inspectorof Wires. T Estimated Value of Electrical Work: l + M (When required by municipal policy.) Work to Start: 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 ] BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of that the information on this application is true and complete. FIRM NAME: Harwich Port Heating &Cooling, LLC ,{ f LIC.NO.:17318A Licensee: Andrew Levesque Signature 22 ,vL� LIC.No.:35976E (If applicable,enter"exempt"in the license number line) Bus.Tel.No.:508-432-3959 Address: 461 Lower County Rd, Harwich Port, MA 02ogo Alt.Tel.No.: *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,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ — Signature Telephone No. a, ** Please fax a copy back to us at 508-S1-6075 ** or e-mail to: kecla©hphcllc.com The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street oston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly Name(Business/Organization/individual): Harwich Port Heating&Cooling LLC Address: 461 Lower County Road City/State/Zip: Harwich Port MA 02646 Phone#: 508-432-3959 Are you an employer?Check the appropriate box: Type of project(required): 1.2 I am a employer with 65 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub contactors 6. Q New constuction listed on the attached sheet. 7. Remodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub contactors have 8. ❑Demolition workingforme in anycapacity. employees and have workers' p ty• t 9. [, Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.M Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.2 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' 13.12 Other HVAC comp.insurance required.] *Any 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. $Contractors 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: Selective Insurance Company of South Carolina Policy#or Self-ins.} Lie.#:' rWC9n0159813 Expiration Date: 10/26/2021� \)n� 'n,� f ' Job Site Address: -` ((/ENV " D STR / 1 City/State/Zip: U `rE j� 1/'-f�NVOu-r`P 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 insurance coverage verification. I do hereby certify under t re i and petia'Ities of pedury that the informations provided above is true and correct. Signature: Date: Phone#: 508-432-3959 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# I� 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#: ii (III HARWICH PORT HEATING&COOLING, LLC Town of Yarmouth Building Department Attention: Ken Elliott 1146 Route 28 South Yarmouth, MA 02664 July 20, 2021 Mr. Elliott, We are requesting an electrical permit for Ocean Vacations, LLC for the property at 4 Glenwood Street, West Yarmouth. The rough wiring was done by others, and we are not responsible for any of that work. We will be confirming the following work, and making any corrections needed to pass inspection. The items that will be requested for finish work will be the second floor bathroom, the furnace, and the hot tub wiring. Because it is unknown to us who did the rough wiring of this work, we will be checking for the presence of arc faults and other code compliance. We understand there may be additional fees required, please email or call Kecia with the amounts. Thank you, Andy Levesque License # 17318A 461 LOWER COUNTY ROAD, HARWICH PORT, MA 02646 TEL. 508-432-3959 OR 800-427-3959 ♦ FAX. 508-432-6075 A