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Home My WebLink AboutBLDE-25-677 v RECEIVED MAY 19 2A Of ,al use On Commonwealth of Massachusetts PermitNo.: i C t----- ,N `L�:_`- 9 Department of Fire Services Occupancy�•ti+�•— Occu anc and Fee Necked: BUILDING D ri Rev. 1/2023 By: : - 14- " :OARD OF FIRE PREVENTION REGULATIONS I "� � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 City or Town of: YARMOUTH Date: OS---) i " To the Inspector of Wires: By this application,the undersigned gives notices of his or her intention to perform the electrical work described below. Location(Street& umber): '3 6/-erg C t'\\rJ Q Unit No.: Owner or Tenant:fil e.ph, Asste..(2 - Po-`k-e),e Email: Owner's Address: /,�‘5>,)._ �u.s, I, C,C G,ljehht4-j 11p96�Y/ Phone No.: Sc'�3&s' ''/-04 Is this permit in conjunction with a buildi g permit?(Check appropriate box)Yes El No❑Permit No.: Purpose of Building: p_� 1e-* ct Utility Authorization No.: Existing Service: Amps / Volts Overhead❑ Underground❑ No. of Meters: New Service: Amps / Volts Overhead 0 Underground❑ No.of Meters: Description of Proposed Electrical Installation: 2_D l� Vol � �s e� �� a Completion of the following table may be waived by the Inspector of Wires. • No.of Receptable Outlets: No.of Switches: Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System 0 No.of Devices: $ Swimming Pool:In-Grnd.❑ Above-Grnd.❑ Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: g No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System IR No.of Devices: . . Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount 0 Ground-Mount❑ Level 1 ❑ Level 2 0 Level 3❑ Rating: OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: -lY av`ter (When required by municipal policy) Date Work to Start: OSSi G/ D-S" Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: 39 CQQ 44/ rr1 s` arc A-1 ❑or C-1 0 LIC.No.: Master/Systems Licensee: 3'�'6.lh`ek 1416-��.r G-t LIC.No.: /3/ Journeyman Licensee: • LIC.No.: ,( Security System Business requires a Division of Occupational Licensure"S"LIC. SS-LIC.No.: S—0 0"U Address: /(7) -DS P 1re- c-� 30, <<-1-1i.._r... Afil- 6J6 Se- Email: p(u i \.S 4 hAtJt- may. Telephone No.: S —3 y(24` `-C-9l I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: P/—± tC, Co wc12-rprint Name: , Q-rf 14 f u e`'- Cell.No.:S"c -3 -U fly INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the Iicensee provides proof of liability 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: 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: Tel.No.: Signature: Email.: I Commonwealth of Massachusetts Official Use Only n '�' :l Department of Fire Services Permit No. L f ! -- a Occupancy and Fee Checked ,��,' BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: 0 S-/9 �.S City or Town of: a,trn-.o 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&^ANumber) iV 6 o/- 1 c-3- C v--le Owner or Tenant/k 'P/ 'e- A-SS c - — (-2- h.-::,;.-,cz P2sz5`1 et)c p Telephone No.5u3-385- .`?-054 Owner's Address /3 7 ( ems, / 3 f 0. Z. c, c 9 y t., )...y,t / 47/9 () (24/ Is this permit in conjunction with a building permit? 4 No (Check Appropriate Box) Purpose of Building �rCa e_el'I-i d Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (---= w t fG /4�>e_ Gr�y��}', a h A cty c-1 -vs. .&." �ha Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans T .of 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. n Deten and I nitiatinggon Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices ,) g Tons Heat PumpNumber Tons KW No.of Self-Contained 6 No.of Waste Disposers Totals: '-" Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ® _e.�'fY.;( Connection ""' tz No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent 5 No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicationsq Wiring: No.of Devices or Equivalent OTHER: G v Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: -'>C> (When required by municipal policy.) Work to Start:(J 1 C,-,?--5 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 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: .'easide Alarms inc. /� , LIC.NO.: 1317C Licensee: Robert K. Boucher Signature 1�_ Pk5- ,osu —LIC.NO.: (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: ;4S-394-0599 Address: 265 Route 28.South Yarmouth, MA 02664 Alt.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: -0046 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)0 owner ❑owner's agent. Owner/Agent PERMIT FEE: $ ,5 Signature Telephone No. / �`L"/S-�a-sz�ea-ea y'l The Commonwealth of Massachusetts ►!=_ _if! Department of Industrial Accidents ;gate- 1 Congress Street, Suite 100 Boston,MA 02114-2017 ' W wwn.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): Seaside Alarms Inc. Address: 1265 Route 28 City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-394-0599 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 19 employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself [No workers'comp.insurance required.] 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 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.: 14. Other Security& Fire Alarm 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 0✓ 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. 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: Hartford Fire Insurance Co. Policy#or Self-ins.Lic.#: 08WECAE7ZU7 Expiration Date: 2/25/26 Job Site Address: All sites 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 certify under the pains and penalties of perjury that the information provided above is true and correct. l Signature: Date: Phone#: 508-394-0599 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#: