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Home My WebLink AboutBuilding Permits (5)Commonwealth of Official Use Only V Massachusetts PermitNo. BLDE-15-00525s 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 ININK OR TYPE ALL a'FORAIATION) Date: 4/28/2015 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of Fus or Her intention per orm the a ec i- work described below. Location (Street & Number) 534 WINSLOW GRAY RD Owner or Tenant YARMOUTH HOUSING AUTHORITY Telephone No. Owner's Address 1146 ROUTE 28. SOUTH YARMOUTH. MA 02664-4463 Is this permit in conjunction with a building permit' Purpose of Building Existing Service New Service Box) No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Exhaust fans & receptacles. (UNIT # 10) Utility Authorization No. Amps Volts Overhead ❑ Undgrd ❑ Amps Volts Overhead ❑ Undgrd ❑ Comaletion ofthe 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- ❑ Crnd. find. No. of Emergency Lighting Battery (nits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatinto Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Ileac Pump Totals: Number Tom KW No. of Self -Contained Deteetion/Alertine Devices I No. of Dishwasher Space/Ana Ileating KW Local ❑ Municipal ❑ Other. Connection No. of Dryers heating Appliances KW Security Sxstems.; No. of evrc s or F, uivalent No. of Water 111V Heaters No. of No. of Sim Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total TIP Telecommunications R'iring: No F. uivof Devices or alent OTHER: Attach admaonat detali tJ aesired oral 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 ❑ BOND ❑ OTHER ❑ (Specify:) I cerdjy, under the pains and penakles of perjury, that the Information on this application Is true and complete. FIRM NAME: CAYTON ELECTRICAL SERVICES INC Llcensee: EDWARD CAYTON Signature LTC. NO.: 14836 (Ifoppllcable, enter exempt -in the license monberline.) Bus. Tel. No.: Address: 251 DAMS RD, WESTPORT MA 02790 Alt Tel No.: 'Per M.G.1 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 signature below, I hereby waive this requirement I am the (check one) Owner/Agent Signature Telephone No. ,/VIfiC ��Pci'e'rca� ❑ owner ❑ owner's agent PERMIT FEE. $50.00 a f , Of5cial Use ony LLJZ �pp c� c� [� is SzS� W an H• 6 .1Jc?e-f�rsrsfof ..Piro J PeffiItNO. cam., ¢ BOARD OF FIRE PREVENTION REGULATIONS Occnpanry add Fee Checked°o -v. 1107] (Iwv- blast) Uj (Y� APPLICATION FRK OR PERMIT TO PERFORM ELECTRICAL WO All wo t m be } rStm� in aacetdznr_ e M=ac!2 � M £lecciml Cad_ (1 -C), V-7 0,M 1 ZDD L!J with th(PLE4SEPRDgTININKORY PE.4LLAVFORM4770Aq Date: It m m City or Town of- �DUTg To the hz =ctor o Wires: Y aPpliczIIM the 1ad_s�ed gives nonce of his Q he intcalon to perform the e�L ^t-tr�1 > � descz�ed baow. Location (Street & Number) I p OwnerorTenant (,/ jagrnvy� Telephone No. Owner's Address _ �/rp Is this permit in conjunction with a but � P'-T�t' Yes No ❑ (Check Baz) Purpose of Entlaieg- Pj(s_ M�S,,P7�7 t�ity AetLo=tion No. Existing Service Amps 1 Volts Over -find ❑ IIa Ord d. ❑ No. of Meters New Service Amps / Volts Overhead ❑ IInd-.rd ❑ No. of Met & Number of Feed—" and :4mpadty Location and Nature of Proposed Electric] Wor+L: (�M?� f'G %STAI L A %Zr Cff. Jysq' J�E1iv i9M /1E:pL�1 1'y��Sii�__G>~CT<AJf'Gn1�ly� nl0 lL�tl /�l�s,�`G�i�iF! .1 C No. of Re�ssed i....,,;,airm c a-m�vi w me olaw:m-tzble �.No of Cel-Sesg. (PaddL-) Fans may be waved a;.oShe l.-n,. epbm o. of Total Transform..-s R�VA No of Lam:,,.:*. pII.� �No of HotTnbs lGene-atom IK-'VA No. of Luminaires ISwimmiag Pool Above ❑ ❑ end °rnd. o of amp �ry : �Esit=^v IIaits No of ��- e(e p No. of Oil Dune s F'fFE pL.e_RINyS •a of Zones No. of SwitchesINo of Gas Bw-a.-s ' o. of a ou and Tnf'•:athg- Devices No. of Races Na of Air Cond. °m Tors No. of AL-r:so Devi No. of Waste Disposers IH mr Pump amD-ec f ors I Tota}s: ho. of Deff oataia-si Devices No, of Dishwashers Space/Area Heating KW' Locl ❑ unidpal Connection ❑ Oth r No. of Dryers o. of ater Heaters I•'W Heating Appliances gW °" ° ho o Sins EaIlzsts 5eemrtry Sp}�s2tceasss• I No. of Device or Enivoent (Data Wirjn; No. of Devices or Fauh No. Hydromassage Bathtubs No. of Motors Total HP aleat Telecommuntc2tloss trines: No.'of Devices or Eanivalent OTHER: ++ uau2u u_. ,. y oerre or ar rey-u1ma t7y the lrrPevor of iPvc• .. Estimated Vzb-- of EI....'cal WorE 0070 r 06 (Men by ==Kips] PovcY.) Work to star= a InsPertiont to be MT=ttd in a(=-, dmce with MEC Rule 10 and INSURANCE COVER,4 I— iialess wzived the MMCr, no etmit for the �1 w on compaction the ticcnsee vida P performance of electrical work may Isaac unless Pro Proof of liabtTrty insoiance inchiding .cO=Plct2d opwatioe tavaage or its substantial cgui Bent Toc undersigned certifies that such eovctzge is in force, and bvs exhibited proof of same to the permit issuing office. CHBM ONF— DZURANCE X BOND ❑ OTIM ❑ (specify:) . I cat:ry, t ndrr the pairs and p=ELL: s ofperjmyg that the informZdan on Phis appEeceSon is true cmd corzplete FIRM NAME- le ell 0r, r1,4 t !/t-�iS LIc xo_i �3 cg Licetuec b.n4itii�1 GAy % Signat:urc LIGNO. fix. (If dyes obte artQ '¢.apt -in licerTe number f' Eta. Tel Now tam 1LFe Addresr. �a� U Alt TelNo:6_p4 6 *Per M G.L c. 147. s. 57-61, security work rsgt ices Department of Public Szfcty "S" License: Lic. No. —""' OWNER'S INSURANCE WAIVER I am awatz that the Uc.-== does nor have the liability *MsU=ce eovmage n rreequimd bye • By my signature below, I hereby waive this requ-Lr= t I am the (cheek oac) (] owner ❑ owner's a ant Signature Telephone No. PERAHTFEE. S l -;,k a, a Commonwealth of Official Use Only � Massachusetts Permit No. BIDE-15-005254 �' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev.1/07 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC). 527 CNIR 12.00 (PLEASE PRAT INIVKOR TYPE ALL LYFOPUL4T/ON) Date: 4/28/2015 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of His or her intention per orm the a ec =work described below. Location (Street & Number) 534 WINSLOW GRAY RD Owner or Tenant YARMOUTH HOUSING AUTHORITY Telephone No. Owner's Address 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit' Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No.ofllfeters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Exhaust fan. Replace receptacles with GFCI's. Disconnect old exhaust fan. (UNIT# 1) Caninletion ofthe follawirm tahle may ho waived by tho Incnorinr of Wiroe No. of Recessed Luminaires No. of CeiL-Susp.(Paddle) Fans No. of Total Transformers KV No. of Luminsire Outlets No. of [lot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ end. end. No, of Emergency Lighting Battery nits No. of Receptacle Outlets No. of Oil Burner FIRE ALARDIS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatin vic . No. of Ranges No.ofAirCond. Total Tom No. of Alerting Devices No. of Waste Disposers fleatPump Totals: Number Tons 1 KW No. of Self -Contained DetectionlAtertiviL Devices i I I No, of Dishwashers Space/Area [Testing kW Local ❑ Municipal ❑ Other. Connection No. of Dryers Heating Appliances KW Security Systems:• No. of fl i s or F. uivalent No. of Water ITV Ileatem No. of No. of Sim Ballasts Data Wiring: No. of Devices or Equivalent No. HydromassageBathtubs No. ofATotors TotalIIP Telecommunications'firing: No. of Devices or E uivalent OTHER: Estimated Value of Electrical Work: Work to start: Attach additional detail ifdeshvit or as required by the Inspector of Wires. (When required by municipal polity.) 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the palms and Pena/ties of perjury, that the Information on this application Is true and complete. FIRM NAME: CAYTON ELECTRICAL SERVICES INC Licensee: EDWARD CAYTON Signature LIC. NO: 14836 (lfapplicable, enter "exempt" in the license timber line.) Bus. Tel. No.: Address: 251 DAVIS RD. WESTPORT MA 02790 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 signal= below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owners agent. Owner/Agent Signature �tiltst iE(oe.fvto+ Telephone No. PERAfITFEE. s5ao0 SlcB�'_S� 8(�S� -,A uj �sn s _ N W� CV U9\cl- uj 'Q [Y. amm,ora,=& o/ //%aiTc� 05eial Use Only �. �c� to� YiwJcrnicca PermitNo._��s'—�i�`1 c-frcr ymd BOARD OF FIRE PREVENTION REGULATIONS Ov'�` Fee Checked LU 1/071 (leave biaak) APPLICATION FOR -*PERMIT TO PERFORM ELECTRICAL WORK ` An Work to be i in n_-c with the Mrssach,: = El=.Xal Cod:WC7 r-7 CMR I2DO (PLE4ZPRINT INiNKORn?EALL INFOPM4y70NJ Dater►.1P,7 s i 15 City or Tovrn of: V�RMOUTg To the Irspecror of Wires: o -. application the trndersiV3 gives notice of his or her intention to - perform the electrical work described below. E Location (Street & Number) I L p�,l( �jH� nG�2� �j 3 L (ilt nt5 tpw �/ f m o -�_ Owner'orTenan[ •y� mu$"j�f, ��7>��7i TetephoneNo. Owner's Address !rjbxf 4_ Is thus permit in conjunction with a brIl dn, Q — . permit? Yes � No ❑ (Chi Appropriate B.)) Purpose of BuSding Utility Authorization Na. Eustis Service Amps / Volts Overhead ❑ IIadgrd ❑ No. of Mks New Service Amps / Volts Overhead ❑ Undgrd ❑ No, of meters Number of Fcders end Ampad p ------------- Loeatioa and Nalatre of Proposed Electrical Woz6: tl1�r/ i a c!7YlL� �r.-r�•ur. Y,rltn..,r ram. No. of Recessed Lanxirsi-es t.ar=Leaor or me Ia lawu a INo. of CeiL-Srsp. (PaddL-) Fans table May be waived I zihE-1=19=10F ofWac No. of Total Transforms,-s KVA No. of Laminaire Outlets No. of Hot Tabs IGeoerrs KVA No. of Lambraires ISwiLne Pool Above o, of tmc henry arm: Brad. ornd. Eatterr Units No of Receptacle OatL-ts o of Oil Emnrs FIRE XLAPMS o. of Zones No. of Switches INo, of Gas Burners ' �o. of errman and Inidatir-- Devices No. of Rang-s INo. of Air Cond. Tom DevicesNo. of Alerting Devices No. of Waste Disposers I ru Number Tors a of elf ontaia-sl TotaLc: Detectiou/Alertine Devices No. of Dishwashers Sp2m/Arm Heatiag KW' Local ❑ naidpal Conn an Od7 No. of Dryers Heating Appliances Ia'W SccSpsums•• No. of Devices E o, of our or eat Heaters KW I o. of Data wuing Boallasts No. of Devices or Eauivalcet No. Hydromassave Bathtubs No. of Motors Total HP Teiecommuatcatiors hang: No. of Devices or Eanivalent OTHER n o ,rnorx deta t g dmvv4 or dr rewired by the Itupejor of ii cez Esd astcd Value of Electnml wort` 7Q a G � trnmicipal polity.) Work to Start H122LIJ Inspections to be requested in =rdance with MSC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the awricr, no permit for the performance of electrical work may ions =IMS the licensx provides proof of lizbility inssatice including "completed opeiatioa" coverage or its substantial e�ttivalent The undersigned ce tifies thzt such coverage is im force, and has alubiL-d proof of sa=e to the permit issuing office. CHECK ONE: INSURANCE ,�5, BOND ❑ OTHER ❑ (Sptcify- I cmtf3', under the pairs and pry ofpinimy, dja the aiforr�+ion on tcs eppTtcchon is e and eoazplde FIRM NAME: / truLIC. NO- 1 gt 6 Licensee /;D rpy , lA Signature � Jh LTC. NO: A d resr. le ter "¢empt'in � %�r;! C ^�i� Bus. Tel. No.= `�a Addresr. G • G `Per KG.L r- 147, s. 57 61, sectut work � " Alt TeL No.4- ry regarres Depattmeat of Public Safety S" License: Lie. No. OWNER'S INSURANCE WAVER: I am aware that the Licensee does nor have the liability insurance coverage normally regti-ed by law. By my signature below. Thereby waive this requirement I am the (check one) I] owner ❑ ownees a essL Owner/Agent Signature Telephone No. PERMIT FEE: S V Commonwealth of official use On►y Massachusetts PermitNo. BLDE-15-005255 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 INKOR TYPEALL I7VF0JUM lIO,VJ Date: 428R015 City or Town of. YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of Fus or her intention per orm Me a ec ice. work described below. Location (Street & Number) 534 WINSLOW GRAY RD OwnerorTenant YARMOUTH HOUSING AUTHORITY Telephone No. Owner's Address 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work. Exhaust fan and receptacles. (UNIT # 8) Completion of the following table may be waived by the Insnector of Wires. No. of Recessed Luminaires No. of CeiL-Susp.(Paddle) Fans No, of Total Transformers KV No. of Luminsire Outlets No. of Hot Tubs Generators k'VA No. of Luminaires Swimming Pool Above ❑ In- ❑ rod. rod. No. of Emergency Lighting Battery snits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Iflitiatine Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Neat Pump Totals: I Number I Tom 1 KW No. of Self -Contained Detection/Alertinr Devices I I No. of Dishwashers Space/Area Heating KW Local ❑ hlunicipal ❑ Other. Connection No. of Dryers heating Appliances KW Security SXstems:• No of Devi es or F. u►valent No. of Water KW Heaters No. of No. of Sins Ballasts Data Wiring: No. of Devices or F, uival nt No. Ilydromassage Bathtubs No. of hfotors Total IIP Telecommunications Wiring: No of D vices or E uivalent OTHER: Estimated Value of Electrical Work: Work to start: Attach additional detail tJ destre4 or at required try the inspector of Wires. (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 equivalenL 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 penahies ojperjuty, that the Information on this application Is true and complete. FIRM NAME: CAYTON ELECTRICAL SERVICES INC Licensee: EDWARD CAYTON Signature LIC. NO.: 14836 (Ifapplicable, enter exempt" in the license namberline.) Bus. Tel. No.: Address: 251 DAVIS RD, WESTPORT MA 02790 AIL 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 signature below, I hereby waive this requiremenL I am the (check one) Owner/Agent Signature Kas ra��sR�~` spa Telephone No. ❑ owner ❑ owner's agent PERA[IT FEE: S50.00 i • L om mora�calJs o�c�//%uner�usa(i t ogcw Use Oafy-7 (1 -Jcj c%+ru,E o .Yuo Jcrvicua 40.eyand P;aln WU-3 6oARD OF F1P.E PREVENTION REGULATIONS7) Fr_'Ch 1:cd I Dl nk) N APPLICATION FOR"PERMIT TO PERFORM ELECTRICAL WORK RK W AU Work c, be iced io at~ =mace winh the l =nc!n=m M===1 Cow (l, q 5a7 ClYM 12.00 0 I.FA.SFPPZ7 NAX OR =E� INF0R 4Yj0NJ Date: � L/ fo1% % �' Uj Z Q o City or Town of: VA_R1�ZOUTH To —"`T the Ir ector o Wires: [� Signed givn5ee of his or bx intantioa to paio� the e�Tr r �1 w°cr d�c�b� blow. m G� Y � �vcadon the Em3a- -s n cation &Number)_ e L Owner'orTeaaat Telephone No. Owner's Address Is this permit in conf=ction with a buds pmmic Yes Ito ❑ (ChankAppropriat BB=) Purpose of Btuldmg f rt)�AI Utrhty Attthaticatinn N0. Service Amps 1 Volts Overhead Q Und.rd ❑ No. of Met.-s New Service Amps 1 Volts Overhead ❑ Undgrd ❑ Nn. of Meters Nmtm -r of Feed"— rnd Ampschy Location and Natar-_ of Proposed Electrical R'ork•. [ - --- fN,tj i/4 C?1� (.L J('�-TC13fit. L Caz�ledrn o ftbe foIIawa e i.ble nzcv be waved by the Ir �e�r otii'ots ' No. of Recessed Lun:dnzirm INo of CeH Scarp Fars �lt o of Tote! (Paddle) ITransfOrmrs KVA No. of Lemiraire Ontiets INo. of Hot Tabs IC{ne atom No m z of Le ,, w ISwir+*±++.b Pool 'move arnd ra Ad. n 01 t a ,eccy tmQ �EsiL-^sIIai� No. of R= eptacle Out-!ts INo of Oil £w-ners FIRE ALARIMS 'o. of Zones No. of Switches INo. of Gas Earn -ems �0. of eteman No. of Rana INo. of Air Cond. Tons Iaidatht-- Devices No, of Alsti�ws De No. of Waste Disposers I umber ons 0. of �elr oarai�o Totals I No, of Dishwashers Spec :(Area Heating W' Det!c'.ionl-41-- tino Dee� vi Local Munn , ❑ Odzer Coanettion o. of D Dryers Heating APP� R'W ppsstteem�s �Na oiD:vi E o. of Heaters KWater o. o a. of Signs Eallasu or eat Data Wiring No. Hydromassage Bathtubs INo. of Motors Total HP No of Devices or zient Telex-ommumcanons Wiring: _— N0.'of Devices or Ecuivaleer Attach additional de:arl f darned or rs square d by time j r Er�=e VzlucofEle.^riczlWmir ('%Oros/ rcPe�oro�Wire. Work to Stint (0`'b rrgrrd by tnnaicipal policy.) kspectioas to be regn=cd in accordncewith MEC Rule 10; mad upon oo=Pletion. 1NSURANC'E COVERAGE: Unless wmived by the owner, no permit for the p=fot1D---nce of elxtrical wore may issu: tml= the licensee provides proof of liabilhy ingormC:e inchtdmg "completed opz,=oa" coverage or its sebstaatiml ecfni lcnt lbe und=`Signed certifies that such coverage is in force, mad bu cibbited proof of sate to the permit issuing oince. C> EM ONE: INSURANCE R BOND ❑ OTHEI:, p (Specify:) I c=*, sr -.der the pairs cud penclr es of 01=7, that the informa6an on ibis eppEcadon is frue msd eornpiete. FIRM NAME: C/(�/,�' L/�L L it S%/ioo ( LIC. NOs { _ 1 Licensee � C,� yam, .I A 5'tgnatnre C�_ ,� Jam• LIC. NOs ifaPPlicable c "¢empr' in these number !us ' Address , o.. Lid�� Oa,a Bus. TeL No , l `Per M.G.L c. 147, s. 57-61. sccun work Alt TeL NosSa�.t J y ty requires D artincat of Public 5afery "S" License: Lie. No. OWNER'S INSURANCE WAIVER• I am awmre that the Licensee does not have the liabr7ity insuraatx coverage normally required by law. By my sigpatnre below. I hereby waive this Tequire 1 a.•n the (check one) ❑ owner ❑ owner's a¢eaL Owner/Agent Sidgnatare Telephone No. PERMIT FEE: S (9 Commonwealth of Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. BLDE-15-005257 Occupancy and Fee Checked ev.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 PR .MIN INK OR TYPEALL INFORAU 77ON) Date:428/2015 City or Town of: YARMOUTH To the Inspector of Wires. By this application the undersigned gives notice of HE or ner imcnuon Lo perform the e ec • work described below. Location (Street & Number) 534 WINSLOW GRAY RD OwnerorTenant YARMOUTHHOUSING AUTHORITY Telephone No. Owner's Address 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Cheek Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity _ Location and Nature of Proposed Electrical Work: Exhaust fans & receptacles. (UNIT # 31) Completion of the following table may be waived by the Inspector of tVires. No. of Recessed Luminaires No. of CeiL-Susp.(Paddle) Fans No, of Total Traniformers KV No. of Luminalre Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above El ❑ gad. rnd. No. of Emergency Lighting Raff ery Units No. of Receptacle Outlets No. of Oil Burner FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and InitiathiL Devices No. of Ranges No, of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number1 Tons KW No. of Self -Contained Detection/Alertin Devices No. of Dishwasher Space/Area heating KW Local ❑ Alunicipal ❑ Other. Connection No, of Dryers heating Appliances kW Security Sxstems:" No. of Devices or Equivalent No. of Water KIV H a rs of No. of S1No, ro Ballasts Data Wiring: No. of Devices or Equivalent No. Ilydromassage Bathtubs No. of Motors Total hP Telecommunications Wiring: No. of Devices or F, uivalen OTHER: Attach aaathonal aetatr p aesvea. or as require Dy the Inspector of wtres. 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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application Is true and complete. FIRM NAD1E: CAYTON ELECTRICAL SERVICES INC Licensee: EDWARD CAYTON Signature LIC. NO.: (Ifapplicable, enter "exempt" in the License number line.) B us. TeL No.: 14836 Address: 251 DAVIS RD, WESTPORT MA 02790 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 signature below, I hereby waive this requirement. I am the (check one) Owner/Agent Signature Telephone No. ❑ owner ❑ owner's agent. PERAIIT FEE: SSO.00 0 1..O/l1flfOrJLL^"^ �ll%sscehJcsa�i Official Uso Oaty BOARD OF FIRE PREVENTION REGULATIONS 0�71 Ftz'CheeL Owe blank) 1CATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wo:t b be pr fxm_ in ottoman-. wny tye M==hus_M Fyzcci=l Cam ct?=- , M Cla 1 200 UWIN&KOR=EAITINFORM4770A9 Date:- l %�Jir 1 or To -vim of: 1 RN_f OUTH To the Inspector of Wires. ation 'ue p�-�i e3 grves nonce of his cr bs inteatim to ptz=' the e1e_^GiMI work dmrnbed blow. W u eei a: Nnmber)_A�%�L 424 - _ Owner-•orTenant l —� 1�2m —ot �9 I s it r- ,�%t,QjW41Y_Telephone No. Owner's Address _�'� lh.� �� ------- IS this permft in conjeaction with a bu1iing peter-h? Yes No ❑ (Check Appropriste Boz) Purpose of Barran j1�J UtM y Author�mtion No. Fi1 Seraica AaFs I' Overhead ❑ Uas R d ❑ New S-svi Amps / volts Overhead ❑ Und:-d ❑ Number of Femme.-s and AmYaci- No. of Met= Nn. of Mete: s !f.4 Mr.4,,A noires c.ar.-�Iear. or the ou--wtez t :ble play be wQvr3 by the Isne�or efA a ¢ No. of CetiSrsp e) Faaso ofTrarsformrs (Padd I,VA EP-e=edu O=Lt; INo. of Hot Tubs G=r ators KVASAbove Ernd_ o oI Lm eecy rmg �Eatt-svII Outiets�1a of Oil Burners ALARMS No. of Zones No. of Switches INo. of Gas Bur amn IN M. of Detecutoz and No. of Ptirgts (No. of Air Cand. Intdatin-g Devi_••es To" No. of A zrtia: Devices No. of Waste Disposers Number [Tons I o. of etf ontameed Totalp 1 Dete�onfAlertins Devices No. of Dishwashers ISpacJArea Hestia: FKR' �l Q Conn%nn a O No. of D au Heatm; Appliances KW psumrV be Na of Drvi� or o, o Heaters °' 01 0. of �t Data Whin; Sipas Bartz No. of Devices or Equivalent No. Hydromassa;e Bathtubss INo. of Motors Total HP Telecommttalcanors irm� No of Devices or 7ivilent OTHER IMnn1. ..riJ:ti—mil J_._I lJ�`_J _ E=ar`td Value of Elwtiml Work: t��Q . - — -- -- ° "" `J`" "r • „`peaor of wire:. Work to Sint � (nza by �icipal pohry.) Lnspeetions to be rognested in actor dance with MEC Rule 1 o, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no pc-mit for the p—_for=znx of ele,^ vital work mzy Isyu tml= the 6censte providm proof of lizbii i insurance inchuag "completed operation" coverage or its substantial equivalent The undersigned ceitiiies that sn b eovezge is in force, and has ahiibh:d proof of same to the pwmit issuing once CHECK ONE. INSURANCE N: BOND ❑ OTHER ❑ (Specify.) r cer*, ender the pairs and pcneldcs of pedjuy, that the utfotmation on this app&ca an is trat and cotspld4 f HthS NAME.LIC. NO_l f f= Licensee: t , 17fapP�51�� t the cau `nwnbar ti„a Sigaatare B� TeL NoO~ Addresr. G /y%� �i TO Art. Tel. No. S `Per M.G.T.. n 1a7, s. 57-61, secvstty work r=pires Die w=cnt of Public Safety "S" License-. Lic No. OWNER'S INSURANCE WAIVER: I as" awzse that the Uc-asee does not have the liabiTsty+*�ce eo a normally-- "eia8 required by lame By say sigaztarc below. I hereby waive this sequiscmeat. I am the (check one) 0 owns ❑ owner's a eat va Oner/Agent Signatare Telephone No. PEBJUIT FEE. S Commonwealth of Official Use Only Massachusetts Permit No. BLDE-15-005258 �—' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ev.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 PR/NT ININK OR TYPE ALL LVFORbfATION) Date: 4/28/2015 City or Town of: YARMOUTH To the Inspector of Wires. By this application the undersigned gives notice of his or her mention to per orm the e ec i • work described below. Location (Street & Number) 534 WINSLOW GRAY RD Owner or Tenant YARMOUTH HOUSING AUTHORITY Telephone No. Owner's Address 1146 ROUTE 28, SOUTH YARMOUTH, MA 02664-4463 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Exhaust fans & receptades. (UNIT # 39) Cotnoletion ofthe followint, table may be waived by the lnrnertnr ofWiree No. of Recessed Luminaires No. of CeiL-Susp.(Paddle) Fans No, of Total Transformers KV No. of Luminsire Outlets No. of Hot Tubs Generators K'VA No. of Luminaires Swimming Pool Arbtodve ❑ I red ❑ No. of Emergency Lighting Battery snits 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 D vie s No, of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No, of Waste Disposers heat Pump Totals: Number i Tons 1 IOW No. of Self -Contained Detection/AtertinL Devices No. of Dishwashers Space/Area heating K\V Local ❑ Municipal ❑ Other. Connection No. of Dryers Heating Appliances KW Securi Sxstems:• No. of yr s or F, a uivalen No. of Water KW Heaters No of No. of Si s Ballasts Data Wiring: No. of Devices or F. uivalent No. Ilydromassage Bathtubs No. of Motors Total HP Telecommunications W'Iring: No of Devices or F. uivalent OTHER: Atlach additional detail ([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 ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penahies of perjury, that the information on this application is true and complete FIRM NAME: CAYTON ELECTRICAL SERVICES INC Licensee: EDWARD CAYTON Signature LIC. NO.: 14836 (lfopplicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: 251 DAVIS RD, WESTPORT MA 02790 Alt. TeL No.: *Per M.G:C 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 signature below, I hereby waive this requirement. I am the (check one) Owner/Agent Signature Telephone No. MiSr- . la�lf- ❑ owner ❑ ownces agent PERAIIT FEE: $50.00 0 N CQ EMRE�ml ommara ccth of ii/aascc��csays O�cw Use Only Fd �(S- S 2� 8 Z c c Pc^.aitNo. W _ p _ ._!Je�c-(,rrnf of ..)`:'e �ertr.,:rt7 ~ BOARD OF FIRE PREVENTION REGULATIONS Ovary and F� Checked .1/071 p z.- blant> APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK Z All Wort to be per5==-d in z==dm ce with the Y.==h=-ems £lc,==a1 e (lam, sal a,M 12.00 o(PLE4.SEPRDATINDX0R=EALLWFOR947YOA9. Date: Li //S- B Cite or Tom n of: TA R N(OUT$ To the Inspector of Wires. By this �Iicatim the tmdersigned -&= notice of his or ber intention to perform the elc=iw1 work desarbed below. Location (Street & Number) 3, L6/12 ✓"A MA 7O A J OwnerorTeasatyriR,�lotlr, /g Vlert ;;' Telephone No. Owner's Address 5�.7%M�, ply -� Is this permit in eonjtra nn with a buldutg p'.rs ' Yes �V N0 El(a�Approp rate Box) Pm pose of Et<l¢sng i -Cf A0cm L Utility Aethari:mtion No. E'd ti & Service AmPs / Vohs Overhead ❑ undrr, d ❑ - No. of Meters New Service -. Amps ) Vohs Overhesd ❑ Undgrd ❑ No. of Mfrs Namb of Feeders sod AmYscity Location and Nstar_ of Propos:.d E =tri=I Wow; f n,P?44 P9 .% rrn» ,..-s-- ,v -•--��.. .rr.rA L:.-.-w1 s/.:=PTNII i 7IIAlT No Of Recessed Lam;..:." INo. of Cal. 5� (PaddL-) Fans may _ w the rear afFars a of otal No. of Lam n a ire Oud. *1a of Hot Tubs' i rzrsform- s KVA G-saators OVA ' No. of Ltamizzires Above IS mRaPool grad. crud. o of r.ma-�a �Eatt_rvUnits C No. of rZe--ptade OatLt; o- of Oil Base.-s AI-4RMS o of Zones No, of Switches INo. of Gas Earners No. of Vet=on and lu testing Devices No. of PugPamgts INo. of Air Cond. otal Tots No. of AL--tfmg Deices No. of Wasu Disposers I p umber ors Iro, of Serf oataia-� Totais: I I DettebonlAlertiao Devi No. of Dishwashers Spae-JAr-s Heating KW- Low, M¢IIieipal Q Coanet an Other No. of Dryers $eating ApPffanear 5ecm try Sppssttces�ss� No. ' o. o our of Device or E alert Heaters KW o Data R''trin; Signs Ballyacte Nn of Devices or uhmient No. Hydmmassa;e Bathtrbs INo. of Motors Total HP ITdxoamra itatioas Wi."utg: Na'of Devices or alent OTHER: Auac h m=mv iv deal f d eb or a req erred by the Ircpe�or of W ve:. Estimated Vzlne of Ele^tical Wxk 6)0 o (When rtci� by mrmicipal policy.) Work to Start l j Iuspe to be ragns:ed in acca:dance with MEC Rule 10, and upon coupI-,Om. INSURANCTE COVERAGE: Unless waived by the owner, no permit for the p--forman= of el,—trical work tray ism. =Iess the licensee provides proof of liabtT inStr c— inchuag -COmply op-ztixt^ ern crzge or its substzztial egziva detsigned certifies lcnt Thetmthai such coverage is is force, HECK and hu ahrbited proof of saw to the pewit issuing office CONE: INSURANCE g( BOND ❑ � OTM ❑ (SpY) I cer*, anda theities an pd p ofPedury, that the h,,fotm=ion on thir epprtccion is b= end emplee FIRM NAME: Ci j C sm"S LIC NO» I�4 Licensee - lam s'tgaatm JA, LIC. NO»� Address: mole Ih license n:anber !in .) Bus. TeL No» *Per M G.L e. 147, ss. 57-b1, secunty work requz2s= DDfecar�cat of Public Safay "S" License: AltLir-No. -� OWNER'S INSURANCE WAIVER: I am aware that the Lit. -as= does not have the liability' rove---�— regttired by law. BY mY signature below, I hereby waive this requircaeni I am the (check out) ❑ owner o ma1� Owner/Agent ❑ oWaa's a cot. Signature Telephone No. PERMIT FEE.- S BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR. RENOVATE, CHANGE THE USE, OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. Town of larmouth Building Department 114ti Route V - Nitrmouth. NIA 02664- 492 Tel: 508-398-2231 ext.1261 Fax 508-398-0836 �'�j L� Office Use Only Planning Planning Board Information Assessors Department Information: Peitfiit"IPo. _5 ��`'w-o Plan Type map Lot Permit Fee $ Endorsement Date Recording Date If New Deposit Rec'd. $ ate plan No 1.4 Property Dimensions: Net Due $ J S 0� other lot area (so - Frontage (rt) lot Coverage This Section for Office Use On Building Pe l urn Slgnatu Building Official Date Issued: d'8 �� Certificate of Occupancy Date is Is not required Section 1- Site Information 1.1 Property Address )l c53 T 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks (ft) Front Yard Side Yards Yard Required Provided Required ProviOed— z:7—?—R—eqL,4rd;EE 13111 Provided 1.4 Water supply (Y.O.t. c. 40.3 541 Public Private 1.5 Flood Zone htfonnad= Ctgm t 15 Zone: BFE: Section 2 - Property OwnershWAuthorized Agent Iuli UIN� pEPAFtTME�r 2.1 Owner of Record: c RRCL e (per) Marling d ess: Soar ,F$ L UN 10101� 9 Z za Signature Telephone Telep a Email Address: J 2.2Authorized Agent ey PARTME�W 2� Dt\ CArn-ti'a-c SV54tk 163 a (pr Mailing Address: x7tr Signature Telephone Fax Email Address: � Section 3 - Construction Services 3.1 Ueensed Construction Supervisor: Not Applicable ❑ 1 I MAi,y 3k (M. W),d MA O 1 ri Vp License Number CS — O � A dress CC// G? 00 M)sCJc rsA—c.r.};JNj4cc% (o NVI% J Expiration Date 3 1 igh Signature Telephone Email Address: )t & 1 of 4 OVER 3.2 Registered Home Company Name Contractor. Not Address Registration Number Expir3!icn Date Signature Telephonet Section 4 - Workers' Compensation Insurance Affidavit (M.G.L C. 152 S 25C (6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit._' Signed Affidavit Attache Yes ........ No .......... Section 5 - Professional Design and Construction Services - for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116 (containing more than 35,000 c-f. of enclosed space) Section 5.1 Registered Architect: NotAppkable ❑ Name (Re4 rst►ant): �\e M[-��tJ f,v�£ S1nttP i _�� A4ceka7)f,--, Mt° Registration Number Address 7 d'1g3�Z;S'6� x Expiration Dais Signature Telephone Section 5.2 Registered Professional Engineer(s) Name Area of Responsibility Address _ Signature Telephone Registration Number Expiration Date Name Area of Responsibility Address Telephone Registration Number Expiration Date Name Area of Resporssbillty Address - Signature Telephone Registration Number - Expiration Date Name Area of Responsibility Address Signature Telephone Registration Number Expiration Date Contractor rSedon5.3eral Not Applicable ❑e for construction Address Signature Telephone 2of 4 ection 6 - Description of Proposed Work (check an applicable New Construction ❑ (for multiple family only) No. of Bedrooms _ Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ I Addition Q Accessory Bldg. ❑ Type Demolition Brief Description of Proposed Work: tv ; t- (for multiple family only) No. of Bathrooms Other . Specify: Section 7 - Use Group and Construction Type Building Use Group (Check as app6capabte) Construction Type A ASSEMBLY • ❑ A-1 ❑ . A-2 ❑ A-4 ❑ A-S A-3 ❑ 1A ❑ 18 ❑ B BUSINESS ❑ 2A ❑ 29 2C ❑ E EDUCATIONAL F FACTORY C3 F-1 F-2 l: H HIGH HAZARD 3A ❑ 3B ❑ 1 INSTITUTIONAL I-1 1.2 ❑ 1.3 0 M MERCHANTILE 4 ❑ R RESIDENTIAL R-1 Cl R-2 ❑ R-3 ❑ SA ❑ se ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ U UTILITY ❑ SPECIFY: SPECIFY: SPECIFY M MIXED USE l3 S SPECIALUSE Complete this section If existing building undergoing renovations, additions and/or change in use. Existing Use Group: Existing Hazard Index 780 CMR 34 Proposed Use Group: Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area Building Area Existing (if applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor (sly Total Area All Floors (sf) Total Height (ft) Section 9 - STRUCTURAL PEER REVIEW (780CMR 11011) Independent Structural Engineering Structural Peer Review Required Yes -........ No ........ - SECTION 10a OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT hereby authorize as Owner of the subject property, to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 3 of 4 OVER 10b OWNER/ AUTHORIZED AGENT DECLARATION ), _'1C � . ��n v , as Owner/Authorized Agent hereby declare that the statements and rm foation on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. S� I Print Name Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (0011ars) to be completed by permit applicant 1. BWId(ng 2. Elecirlml 3. Plumbing I Gas 4. Mechanical (HVAC) 5. Fire Protection S.Total .(Ia2*3+4+5) 7. Total Square Ft. riwn u m a awwo Check Below ❑ Conservation -Commission FTng . (if applicable) ❑ Old Kings Highway & Historical Commission approval (if applicable) Date 4 of 4 OWNER -CONTRACTOR AGREEMENT Commonwealth of Massachusetts -Department of Housing and Community Development This agreement made the 30th day of March, 2015 by and between the Yarmouth Housing Authority hereinafter called the "Owner", and MJS Construction, Inc., hereinafter called the'Contractor". Witnesseth, that the Owner and the Contractor, for the consideration hereinunder named, agree as follows: Article 1. Scope of Work: The Contractor shall perform all Work required by the Contract Documents for Selective Porch and Deck repairs at the 667.1 elderly housing development #351029 prepared by Arnold Jacobson Associates., acting as and referred to in the Contract Documents as the "Architect". Article 2. Time of Completion: The Contractor shall commence work under this Contract on the date specified in the written 'Notice to Proceed" and shall bring the Work to Substantial Completion within 90 calendar days of said date. Damages for delays in the performance of the Work shag be in accordance with Article 9 of the General Conditions of the Contract Article 3. Contract Sum: The Owner shall pay the Contractor, in current funds, for the performance of the Work, subject to additions and t luctions by Change Order of the Contract Sum of: FORTY-THREE THOUSAND, NINE HUNDRED -NINETY NINE DOLLARS 999.00 . Article 4. The Contract Documents: The following, together with this Agreement, form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forms, Conditions of the Contract and Specifications as enumerated in the Table of Contents, the drawings as enumerated in the List of Contract Drawings, DHCD publication known as the Construction Handbook, and all Modifications issued after execution of the Contract Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions. Article 5. REAP Certification: Pursuant to GL a62(c) §49(a), the individual signing this Contract on behalf of the Contractor, hereby certifies, under the penalties of perjury, that to the best of their knowledge and belief the Contractor has compried with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support Article 6. Worker Documentation Certification: In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract that pursuant to federal requirements, the Contractor shalt verify the immigration status of all workers assigned to such contract without engaging in unlawful discrimination; and that it shall not knowingly or recklessly alter, falsify, or accept altered or falsified documents frorn any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, Including but not limited to monetary penalties, withholding of payments, contract suspension or termination. , Article 7. Validation: This Contract will not be valid until signed by the Undersecretary of the Massachusetts Department of Housing & Community Development or its designee. In Witness Whereof, the Parties Hereto Have Caused This Instrument to be Executed Under Seal, ICONTRACTOR MJS CONSTRUCTION, INC. Name or Contactrx `�� 1AfcJiess: 2 AWARDING AUTHORITY YARMOUTH HOUSING AUTHORITY Name of Housug AutitorilY " Sgnam�e/� Title ^ Attest N signed by someone otler than a Haaag A' Board member attach a copy of Certified Board Vole authormng the signatory to sign Contract. OF HOUSING & COMMUNITY DEVELOPMENT I gHCD . 15 Owner/Contractor Agreement I orl t• The Commonwealth of Massachusetts Department of Industrial Accidents Ofj`ice of Investigations 600 Washington Street Boston, MA 02111 .www,massgov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information ptol2co T)A"+ r Name (BucineWOrganintion/Individual):_ � JCj Address:_ 7 ' \ ("Act,, I i l,Q l City/State/Zip: A�U, 1212L kAA OkTZO Phone n Are you mployer? Check the appropriate box: 1. I am a employer with _� 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).' 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors . listed on the attached sheet. 6. ' ❑ New construction 7. ;►remodeling . ship and have no employees These sub -contractors have 8. ' ❑ Demolition working for mein any capacity. [No workers' comp. insurance employees and have workers' comp. insurance,: 9• ❑ Building addition required:] 3. ❑ I am a homeowner doing all work 5. We are a corporation and its officers have exercised their • 10.❑ Electrical repairs or additions 1 I.Q Plumbing repairs myself [No workers' comp. insurance right of exemption per MGL or additions 12.❑ Roof repairs required.] t 3a ❑ I am a homeowner acting as a c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other general connector (refer to #4) . , Comp, insurance 1. 1 fAnY applieaat spat cheeks box #1 must also fill our the section below showing d,eirwarkers' compensatio$policy in�on. Homeowner who submit this affidavit indicating they are doing all work and then hire outside eonimctors tnau submit a new affidavit indicating socL tCoattacton that check this box trust attached sa additional sheet showing the name of the sob conCaasots s d sram whetber trr not those =tities bave employees. If the sub-concamms have employees, they roust provide their workers,policy mmbc comp p cS' l am an employer that is providing workerscompensation insurance for nmy information. employees. Below is the policy and job site NAInsurance Company Name• - S � ) zr-. Polity # or Self --ins. Lic.('3 Expiration Date - ___I $ Job Site Address: S?�`{ W;nslo..� G� ,� City/Statemp:S A0-10 Oab6y Attach a copy of the workers' compensation policy declaration page (showing the policy ram er and expiration date). 1 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 etrn+ under the sins d pt>ialtia perjury at the injorntation provided above is true and correct Si atntt;• /J�\ Offi al 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): L Board of Health 2. Budding Department 3: City(Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: Information and Instructions Eo to workers' comQeasadoa foe then employe. Messachtuctu General Lays chapter 152 requires all emp ydr:. provide coctraci of hire, pursuant to this statute, an easplgn is defined as "—every person in the service of another undd any express a implied, oral of written" An naep% is defined z: "an individual, partnership, aasocuhon, corporation of other legal entity, or any two cc more m a )fat and iacbrding the legal Wives of a dressed employer, ere the of the forrtoing engaged J enterprise, receive a h: ustee of an b&Yidsnl, putoership, b0° or other Ind entity, empaoyias e�bYe • liawever the owner of a dwelling house having not mote than three apartments and who resides tbexeia, a the occupant of the persona to do maktcna coach =*u or repair wort on such dwelling bosse dwelling house of another who a mpbys therzta shall not because of such employment be deemed to be as employer." or oa the grounds or bufl&g agpurt-aunt ,MGL chapter 1529125C(t7 also states that "every state or localHceusfng spwy shag withilow tnmosts►ait s uyor renewal of a lkense or paraft to operate a busineaa or to cnnshrud baud&& " appaks d WM bats not produced seteptsbloe erld . of eompa mm with the lances coveragen4� Addid=197, MGL chapter 152,125 M states "Neither the commonwealth nee any of its POE601 subdivis = sha11 enter into any contrsd for, the perms of gobtie work until acceptable- evidence of tom palace with the irsurmce . rrquiiemeatz of this ebapter have been presented to the contracting may" Appucaats please ® out the workers' compensation affidavit completely, by checking the boxes that apply to your situstian 24 if necessary, supply sub..c scto s) name(s), s&kc a(es) and phone'un ba(a) slang with their catiScate(a )other than the (LLC) a Limited Liabrlfty Partnerships (Lip) wrth no employees nxm*act' pant a Z'.mabfii t resuranee. of an LLC a LLP does bm rntmbers or partners, are not rum to esrcy workers, eompetsaban � . emplores, a policy is reguared. Be advised that this affidavit nosy be suboatted to the Department of Indhrahial Aoofdeats fat eonfirmzb= of inn= " Aber be sure to sfga and data tine zMaTtL The affidavit should be rstuaned to the city a town that the uapplicad= for the permit err,;cease is being regrusted. net the Department of Indu:ndal Aaidef. ShonM you have any goestiooa repzd=g the law os if you are required d to obtain a should enter campeaution paIiey, please call the Depornaed at the number listed below. Self -insured compeaies abourW cafes their self-maeanca licence mint on the spocamille liar. City or Town Oft'dMia plcaae be sure d= the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidsvft for you to fill art is the event the Office of hwesugstians has to cotitsd you regarding the applicau plem be sure to AU in the permi!llicense number wbich will be use d as a reference uruaaber. In addition, an applicant that rasubmultiple pen tT=me appliaboos in any given: ves Year, need only submit am sf$davit indicating current policy information (i f neceesuy) and under "Job Site Address" the applicant should writs "all locations in (city or town). A copy " of the affidavit that has been of&fslfy stamped or narked by the city or town may be pfavided to that applicant as proof that a valid affidavit is on fik for tat= permits or Boca= A new affidavit mud be filled out each yea. Where a home owner at citizen is obtaining a license or permit not related ter any business cc commercial Ventre (Le. a dog license or permit to In= Ica e' etc.) said person is NOT required to complete this affidtvit. The Oflke of Invesdgstiaas would like to thank you in advance foe your cooperation and should you have any questions, please do not hesitate to give us a all. Tie Deput nest's address. telepbone and fez number. The Commonwealth of Massachusetts Department of Industrial Accidents Oflle: of Investiptions 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 11-224)6 www.n=s.gov/dia TOWN OF YARMOUTH •3 e O Y `•�; BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT: job Location:- �3y 1,Jtv,�l.�,,) Gri Number Street Owner of Property - Village Construction Supervisor. MN m� �,L � CS'— L Ol y 10 917 Mpg (1 �(o License No. Phone No. Address: Licensed Designee: (If other than Supervisor) Name 2.15 Responsibility of each license holder. License No. 2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings as approved by the building official. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even though he, the license holder, is, not the permit holder but only a subcontractor or contractor to the permit holder. 2.15.3 The license holder shall immediately notify the building official in writing of the discovery of any violations which are covered by the building permit. 2.15.4 Any licensee who shall willfullyviolate subsections 2.15.1. 2.15.2 or 2.15.3 or anyother section of these rules and regulations and any procedures, as amended, shall be subject to revocation or suspension of license by the board. 2.16 All building permit applications shall contain the name, signature and license number of the construction supervisor who is to supervise those persons engaged in construction, reconstruction, alteration, repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longersupervising said persons, the work shall immediately cease until a successor license holder is substituted on the records of the building department. 2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may be deemed a violation of the permit conditions. I have read and understand my responsibilities under the rules and regulations for licensing construction supervisors in accordance with section 109.1.1 of the state building code. I understand the construction inspection procedures and the specific inspection as called for by the building official. INSURANCE COVERAGE: I have a current lia ility Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152 Yes No ❑ If you have checked yu, please ia type coverage by checking the appropriate box. A liability insurance policy . ndicatOther type of indemnity ❑ Bond OWNER'S INSURAN E WAIVER: I am aware that the licensee does not have the insurance coverage required by Ch ter 52 of the Ma Gen nd that my signature on this permit application waives this requirement Check anA Ignature of Owner or Owners Owner (� Agent Signature: Building Official Approval: TOWN OF YARMOUTH BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext.1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111 S, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at QX W,'nslo,a (NrFu iz Work Address Is to be disposed of at the following location: J 14ziA Ct4L,3 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. Signature of Application Permit No. Z 7 ate • SELECTIVE PORCH AND DECK REPAIRS (2014); 667-1 YARMOUTH HOUSING AUTHORITY DHCD PROJECT # 351029 SECTION 06.10. 00 ROUGH CARPENTRY PART 1-GENERAL 1.01 PROVISIONS INCLUDED A. The conditions of the Contract and other Section of Division 1, General Requirements, apply to work under this Section. B. Examine all of the Contract Documents for requirements which affect work of this Section whether or not such work is specifically mentioned in this Section. The exact Scope of Work of this Section cannot be determined without a thorough review of all Specifications and other Contract Documents. C. Coordinate work with that of all other trades affecting or affected by work of this Section. Cooperate with such trades to assure the steady progress of all work under Contract D. It is the intent of the Specifications and the Drawings to require that the equipment to be furnished complete In every respect, and that this Contractor shall provide all equipment needed and usually furnished in connection with such systems to provide a complete installation. Equipment, materials, and articles incorporated in the work shall be new and of the best grade of their respective kinds. .02 WORK TO BE PERFORMED ' A. Furnish all labor, materials and equipment necessary to complete the Rough Carpentry required for the project, including but not limited to the following: 1. New 1 x 6 pressure treated wood decking as shown on drawings. 2. New pressure treated floor joists for sistering where shown on drawings. 3. New pressure treated 2 x 8 rim joists where indicated on drawings. 4. New 1 x 10 and 5/4' x 9-1/2' trim boards where indicated on drawings. 5. Miscellaneous framing and blocking as shown on the drawings and/or required to complete the work of this section and related sections. 6. New 4 x 4 K.D. post — painted where shown on drawings. B. Examine Contract Documents to determine full extent of work of this section required. 1.03 RELATED WORK SPECIFIED ELSEWHERE A. The Contractor shall be responsible for confirming work which may be related to and requires coordination of other sections of the specifications to be performed by others. 1.04 SUBMITTALS A. Submit in accordance with Section 01.33.00, SUBMITTALS. B. Shop Drawings showing framing connection details, fasteners, connections and dimensions. 1.05 PRODUCT DELIVERY. STORAGE AND HANDLING A. Protect lumber and other products from dampness both during and after delivery at site. B. Pile lumber in stacks in such manner as to provide air circulation around surfaces of each piece. Stack plywood and other board products so as to prevent warping. C. Locate stacks on well drained areas, supported at least six inches above grade and cover with well ventilated sheds having firmly constructed overhanging roof as well as sufficient end wall to protect lumber from driving rain. ROUGH CARPENTRY 06.10.00 1 of 4 7/102015 SlipGen- Portal Hone Town of Yarmouth Template [Building Dept] ■ Slipsheet Identifier [sg32078] Document Category Building Permits Map -Block Number 059.44 Street Number 0534 Street Name WINSLOW GRAY RD Department Building Parcel ID 8351 Backfile Batch Scan No Document? Additional Naming Info Index Operator Operator, Yarmscan Date - Time 2015-07-10 - 13:08 tttpJAaserfiche12G1pGerV 1/1