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Home My WebLink AboutBLDE-22-000707 Commonwealth of Official Use Only ((t' Massachusetts Permit No. BLDE-22-000707 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:8/9/2021 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) 37 ARTHUR LN Owner or Tenant OAKS CAROLYN Telephone No. Owner's Address 135 AMHERST ST UNIT 5, AMHERST, NH 03031 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 0 Undgrd 0 1 2,o M s New Service Amps Volts Overhead 0 Undgrd 0 o.of A. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring of porch&add receptacle for water heater. 41'n:20 4%11.1,- A, Completion of the following table may be lia' d he! e ,f Wires. No.of Recessed Luminaires No.of Ceil.-Sus . Paddle Fans 1 No.of '2 • Ap( ) Transformers (3!/ ANo.of Luminaire Outlets No.of Hot Tubs - Generators J//,47T el No.of Luminaires Swimming Pool Above ❑ In ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 8 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 Tons 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 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 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: RICHARD A HAARMAN Licensee: Richard A Haarman Signature LIC.NO.: 33511 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 18 Holmes Rd, Harwich MA 026452219 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: $50.00 aa� �jOfficial Use Only Commonwealth o�///a��ac�e� Permit No. � -O7 U 1 w �C=" 2Jepartment o` ire ervicet E+-_ — Occupancy and Fee Checked — - BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07] ":,y.� (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 INFORMATION) Date: 8/3/2021 City or Town of: Yarmouthport 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)37 Arthur Lane Owner or Tenant Oakes Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Appropriate Box) Purpose of Building Dwelling Utility Authorization No. Existing Service 200 Amps 120 / 240 Volts Overhead ❑■ Undgrd n No.of Meters 1 New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wire new Screened Porch,Add GFCI outlet for tankless water heater in basement Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 Tf T Transformers KVA No.of Luminaire Outlets 4 No.of Hot Tubs Generators KVA Above(--1 In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. I I grnd. Battery Units No.of Receptacle Outlets 8 No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches 3 No.of Gas Burners No. Initiatinnggon Dete and n Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW tNo.of Self-Contained P Totals: Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local E Municipal ❑ Other PConnection , 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 NofDeiceor Wiring: Y g I No.of Devices 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: 8/1/2021 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 perjury,that the information on this application is true and complete. FIRM NAME: Snows Fuel, LLC. LIC.NO.: 8175 Al Licensee: Richard A Haarman Signature % LIC.NO.: 33511 E (If applicable,enter "exempt"in the license number line.) �� Bus.Tel.No.: 508-255-1090 Address: 18 Main Street Orleans,MA 02653 Rick@Snowsfuel corn Alt.Tel.No.: 508-789-5410 *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 Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts z 1= Department of Industrial Accidents =_;iel� 1 Congress Street,Suite 100 ♦,—'1'F= Boston,MA 02114-2017 E •`.: www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Snows Fuel, LLC. Address: 18 Main Street Orleans, MA 02653 Rick@Snowsfuel.com City/State/Zip: Orleans, MA 02653 Phone#: 508-255-1090 IAre you an employer?Check the appropriate box: LIE('arr.a c uployei With 18 employees(full and/or part-time).* Type of project(required): 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. ❑Remodeling 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ['Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.ro I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑✓ Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.Z Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance. 13.0Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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. :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. Federated Mutual Insurance Co. Insurance Company Name: Policy#or Self-ins.Lic.#: 6091606 1/01/2022 Expiration Date: Job Site Address: 37 Arthur Lane Yarmouthport Brewster, MA 02631 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' er the s and penalties of perjury that the information provided above is true and correct Signature: Date: 1 — ,e/ /2/ Phone#:508-255-1090 ext 187 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#: