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Home My WebLink AboutBLDE-22-002526 Commonwealth of Official Use Only 41 Massachusetts Pennit No. BLDE-22-002526 '`— 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:11/3/2021 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) 95 PLEASANT ST Owner or Tenant George Rodrigues Telephone No. Owner's Address 95 Pleasant Street, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Ch Box) Purpose of Building Utility Authorization N Existing Service Amps Volts Overhead 0 Undgrd 0ill't►. r>� New Service Amps Volts Overhead 0 Undgrd 0 o e f s Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Complete wiring of pool equipment started by others. DO Completion of the following table may e °, t, pector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers / Q KVA �i No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- l] No.of Emergency Lig tins 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/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 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: Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 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 .RECEIVED will Cc(,l l LwovJ co......,....,Mo.siocitudetts Offi vial Use Only cc�� 7'I �(�i Permit No. .2`i/ ' 2l.parlm.nt a ie.&rorc.i BUILDING "( NT By: \ s 1/t' Occupancy and Fee Checked ---:aARD OF FIRE PREVENTION REGULATIONS [Rev.I/07] (leave blank) a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK V 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: //-oa—a OR / o City or Town of: /h f�I`l p k TH To the Inspector of Wires: r By this application the undersigned gives notice of his or her ian to perform the electrical work described below. tr Location(Street&Number) 95 PLEASANT S7 J'ogq fiamou7,iV/a o?bb L/ ne or Tenant G3eoRGE RDDRXG4E5 Telephone No. 703-726--89S/ ' Owner's Address 7 PLEfi-SANT cST, S'ouTH YARNowTN,MA 0&6bq Is this permit in conjunctio�n/with a building permit? Yes' No 0 (Cheek Appropriate Box) z � Purpose of Building A' ,GILt t.CZ-- Utility Authorization No. �`) Existing Service.)00 Amps pc)/-7voVa, OvaipU i l Undgrd❑ No.of Meters / Z New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters CI Number of Feeders and Ampacity 04 Location and Nature of Proposed Electrical Work: 7,5 PL EASAJU/IT 10li77/ Yi 0 oa7H .. CoWI pI rz±E' ILt FI vl5 cr fool tzu:pm ei 7c V) Completion of the following_table may be waived by the I for of Wires. Lb No.of Recessed Luminaires No.of CAM-Snap.(Paddle)Fans No.a of KVA Transformers KVA C1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above hi- No.of Emergency Lighting . No.of Luminaires Swimming Pool grad. 0 grnd. 0 Battery Units No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones and Z- No.of Switches No.of Gas Burners -No.Ini a ingon Devices Devices Ili No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Po Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipnnectioal n er Otb Co No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water -No.of No.of Data Wiring: KW Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromasaage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: �y Attach additional detail if desired.or as required by the Inspector of Wires. Estimated Value of Electrical Work:{7 3- - (When required by municipal policy.) Work to Start:(i—00-o70oZ I 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 0 (Specify:) I certify,under the pains and penalties of pedttry,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: LAX EItt•(Pr Signatur 0 2j�j,pzey..„ LIC.NO.: 1I7 applicable,enter"exempt"in the license number litre. _dd Bus.Tel.No.: Address: 9 ('Lee?Sgy't 50Y1/lr f fAWle/ILIA C26 ' Alt.TeL No.:703—vs-99S/ °Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"5"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability inurance coverage normally required by law��J�By my signs low,I hereby waive this requi t. I am the(check one) wner ❑owner's agent. Owner/Age, °�-77 Signature /Al", .4.7. -- Telephone N 7°3)701-5 8957 I PERMIT FEE:$ S.0 _ The Commonwealth of Massachusetts =x, _ Department of Industrial Accidents 1 Street,Congressee, Suite 100 Boston, MA 02114-2017 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): �--EO R6 f 61.klC Llis Address: ? n S4N r - r (5c k 7 l )/Q,<nio te ly/ /'vt/1 o a 6 6 y City/State/Zip: s°`MTh rO/ti 0uTT/ Phone #: 7°) — T a S ' ' .S7 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7, ❑ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.'I am a homeowner doingall work myselft 9. ❑Demolition ys [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.(A Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 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.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: fS e�Q, jT pry Xvo a pry City/State/Zip: NA 0a Cr 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 c under the pains an penalties of perjury that the information provided/above is true and correct. Date: / Signature- Phone ' l o� 9. #: 07 7 S- " 0 girl 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#: George Rodrigues 11/2/2021 95 Pleasant St. South Yarmouth,MA 02664 Ken Elliott Electrical Inspector Town of Yarmouth,MA Dear Mr. Elliott, I am writing to inform your office,that I have released our electrical contractor(Knight Electric)for failing to deliver services as promised. The contractor has repeatedly not showed up to complete the work at our primary residence, 95 Pleasant Street, South Yarmouth,MA causing significant delays. The work Knight Electric was performing was part of the installation of an in-ground swimming pool at our home at, 95 Pleasant Street, South Yarmouth, MA 02664. As of this date, Knight has passed two of your inspections and I believe, had only a final inspection remaining. As the homeowner, I would like to apply for a new permit to finish the remaining work myself. Thank you very much for your consideration. VeryRes ctfiill Pe Y, 414,4 X,(50‘2,19441 ).- George Rodrigues