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The Massachusetts Permit Electrical form is a critical document administered by the Commonwealth of Massachusetts Department of Fire Services Board of Fire Prevention Regulations, tailored for individuals or entities intending to undertake any electrical work. This form aligns with the Massachusetts Electrical Code (MEC), ensuring that all electrical undertakings conform to established safety and quality standards. Applicants are required to meticulously fill out the form, providing comprehensive details such as the location of the proposed work, type and scope of electrical tasks, estimated value, and the start date of the work. Essential elements like insurance coverage or waivers thereof must be declared to safeguard both the licensee and the property owner against potential liabilities. Additionally, the form serves to streamline the inspection process, directing requests in accordance with MEC Rule 10. For contractors and electricians, it includes a Workers’ Compensation Insurance Affidavit section, highlighting the state's mandate for employers to furnish suitable workers' compensation insurance, thereby underlining the form's role in upholding legal and safety obligations in electrical work across Massachusetts.

Massachusetts Permit Electrical Sample

Commonwealth of Massachusetts

Department of Fire Services

BOARD OF FIRE PREVENTION REGULATIONS

Official Use Only

Permit No.

Occupancy and Fee Checked

[Rev. 1/07]

(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:

 

City or Town of:

 

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)

 

 

 

 

 

 

 

 

 

Owner or Tenant

 

 

 

 

 

 

 

 

 

Telephone No.

 

Owner’s Address

 

 

 

 

 

 

 

 

 

 

 

 

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:

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

 

 

 

 

 

 

 

 

 

 

 

 

 

Above

In-

No. of Emergency Lighting

 

No. of Luminaires

 

 

Swimming Pool 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.

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

Municipal

Other

 

 

 

 

Connection

 

 

 

 

 

 

 

 

 

 

No. of Dryers

 

 

Heating Appliances

 

KW

Security Systems:*

 

 

 

 

 

No. of Devices or Equivalent

 

 

 

 

 

 

 

 

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

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:

 

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:

 

 

 

 

 

LIC. NO.:

 

 

 

 

 

 

 

 

 

 

 

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:

 

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.

The Commonwealth of Massachusetts

Department of Industrial Accidents

Office of Investigations

600 Washington Street

Boston, MA 02111

www.mass.gov/dia

Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers

Applicant InformationPlease Print Legibly

Name (Business/Organization/Individual):______________________________________________________

Address:__________________________________________________________________________

City/State/Zip:_____________________________ Phone #:________________________________

Are you an employer? Check the appropriate box:

Type of project (required):

1. I am a employer with _________

employees (full and/or part-time).*

2. I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers’ comp. insurance required.]

3. I am a homeowner doing all work myself. [No workers’ comp. insurance required.]

4. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have workers’ comp. insurance.

5. We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers’ comp. insurance required.]

6. New construction

7. Remodeling

8. Demolition

9. Building addition

10.Electrical repairs or additions

11. Plumbing repairs or additions

12.Roof repairs

13. Other____________________

*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 their workers’ comp. policy information.

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:

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 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 the pains and penalties of perjury that the information provided above is true and correct.

Signature:Date:

Phone #:

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 #:_________________________________

Form Breakdown

Fact Detail
Governing Law Massachusetts Electrical Code (MEC), 527 CMR 12.00
Form Use Application for Permit to Perform Electrical Work
Submission Requirement Must be printed in ink or typed
Insurance Coverage Requirement Proof of liability insurance including “completed operation” coverage or its substantial equivalent is required unless waived by the owner.
Permit No. To be left blank for official use only
Workers’ Compensation Insurance Affidavit Must be completed and attached acknowledging workers' compensation insurance status
Perjury Statement Applicants certify under the pains and penalties of perjury that the information provided is true and complete
Owner’s Insurance Waiver A provision for the owner to waive the liability insurance coverage normally required by law
Inspection Requirement Inspections to be requested in accordance with MEC Rule 10, and upon completion of work
Supporting Documentation Additional detail or documentation can be attached as required by the Inspector of Wires or as desired by the applicant

How to Write Massachusetts Permit Electrical

Filling out the Massachusetts Permit Electrical form is a fundamental step for ensuring that electrical work is conducted legally and safely within the state. This document serves as a formal request for permission to undertake specific electrical projects, verifying that the proposed work aligns with state regulations and safety standards. Completing this form thoroughly and accurately is critical for obtaining the necessary approval from local authorities. Here are the steps you need to follow to accurately fill out this form:

  1. Date: Enter the current date to document when the application is being submitted.
  2. City or Town of: Specify the city or town where the electrical work will be performed.
  3. Under “To the Inspector of Wires”, provide your name to indicate who is submitting the application.
  4. Location (Street & Number): Include the full address where the electrical work will occur.
  5. Owner or Tenant Telephone No.: Fill in the contact number of the property owner or tenant authorizing the work.
  6. Owner’s Address: Provide the address of the property owner.
  7. For the question “Is this permit in conjunction with a building permit?” check the appropriate box (Yes or No).
  8. Fill in the Purpose of Building, Utility Authorization No., details about Existing Service and New Service including amps, volts, and whether the service is overhead or underground, and the No. of Meters.
  9. In the section designated for the Location and Nature of Proposed Electrical Work, list all relevant details about the project, including the number of devices, outlets, fans, lighting, and any other electrical components involved.
  10. Estimated Value of Electrical Work: Specify the total estimated cost for the electrical project.
  11. Indicate when the Work to Start and acknowledge that Inspections will be requested in accordance with MEC Rule 10.
  12. Under INSURANCE COVERAGE, mark the appropriate box to show whether you are providing an Insurance, Bond, or Other form of coverage and certify the information provided.
  13. Complete the “FIRM NAME,” “LIC. NO.,” and contact information for the licensee performing the work.
  14. If applicable, fill out the OWNER’S INSURANCE WAIVER section.
  15. Enter the PERMIT FEE amount, if known.
  16. Sign and provide telephone numbers in the indicated areas for both the applicant and the owner/owner’s agent (if applicable).
  17. Complete the Workers’ Compensation Insurance Affidavit section at the bottom of the form, selecting the status that accurately describes your employment situation and providing insurance details if applicable.

Once you have completed all the necessary sections and signed the form, submit it to the local Inspector of Wires for review. Remember to keep a copy for your records. Approval of this permit is a crucial step in moving forward with your electrical project, ensuring that all work performed is up to code and meets safety standards. Compliance with these regulations not only protects the property but also ensures the safety of all individuals involved.

Discover More on Massachusetts Permit Electrical

What is the Massachusetts Permit Electrical form used for?

The Massachusetts Permit Electrical form is an official document used to notify the local Inspector of Wires about the intention to perform electrical work. This work must comply with the Massachusetts Electrical Code (MEC), 527 CMR 12.00. The form outlines details about the location, nature, and specifications of the intended electrical installations or alterations, including lighting, wiring, and power setups.

Who needs to fill out this form?

This form must be filled out by licensed electricians or individuals planning to perform electrical work in Massachusetts. It is required for both new installations and modifications to existing electrical systems. Homeowners who intend to undertake electrical work themselves should also fill out the form, adhering to the state's regulations and safety standards.

Is insurance coverage necessary for the issuance of an electrical work permit?

Yes, unless waived by the owner, proof of liability insurance, including "completed operation" coverage or its substantial equivalent, must be provided for the permit to be issued. This ensures that the electrician or firm performing the work is covered in case of accidents or damage resulting from the electrical work.

Can the permit application be waived for certain types of work?

Completion of the detailed table in the application, which lists the specifics of the electrical work, may be waived by the Inspector of Wires. However, this is at the discretion of the inspector and usually depends on the complexity and scope of the work being proposed.

What is the Workers’ Compensation Insurance Affidavit section for?

The Workers’ Compensation Insurance Affidavit section is required to verify that the applicant has workers’ compensation insurance coverage for their employees, as mandated by Massachusetts law. It is essential for employers to complete this section accurately to avoid legal penalties, including fines or imprisonment for failing to secure proper coverage.

What happens if a homeowner decides to perform the electrical work themselves?

Homeowners who choose to perform the electrical work themselves must still complete the permit application, including the Workers’ Compensation Insurance Affidavit section, indicating they're doing all the work personally and do not require workers' comp insurance. If they later decide to hire contractors, they must submit a new affidavit indicating the change.

Common mistakes

When individuals attempt to fill out the Massachusetts Permit Electrical form, several common mistakes can lead to delays and complications in the permitting process. Being aware of these pitfalls can streamline one's application and facilitate a smoother, more efficient path towards beginning electrical work legally and safely. Below are six frequently encountered errors:

  1. Incomplete information: Every section of the form requires careful attention. Applicants often overlook or only partially fill out sections such as the "Purpose of Building" or specific details about the type and scope of electrical work to be undertaken. This can result in a requirement for additional documentation or even rejection of the application until completed satisfensively.
  2. Failing to check the appropriate boxes: Particularly in sections requiring a selection between 'Yes' or 'No', such as if the work is in conjunction with a building permit, applicants sometimes leave these critical boxes unchecked. This can cause confusion and may require further clarification, delaying the permit process.
  3. Incorrectly completed insurance coverage section: Proof of liability insurance is a crucial component of the permit application. Applicants must not only check the correct box to indicate the type of coverage ("INSURANCE", "BOND", or "OTHER") but also ensure that the insurance information is accurately and fully provided. Skimping on this detail can halt the application progress.
  4. Error in licensee information: The section requiring information about the licensee, including their name, license number, and business telephone number, is frequently prone to inaccuracies or typos. This might cause delays in verification and processing of the application form. Cross-checking this information for accuracy before submission is advisable.
  5. Workers’ Compensation Insurance Affidavit issues: Completing this section inaccurately, especially regarding employment status and insurance details, can lead to legal and procedural complications. It's vital to ascertain the correct employment status and provide accurate insurance policy details if applicable.
  6. Signature omissions: The form requires multiple signatures: from the applicant certifying the completeness and accuracy of the information, from the owner or owner’s agent waiving insurance requirements if applicable, and at the bottom of the Workers’ Compensation Insurance Affidavit. Missing any of these signatures can invalidate the application.

A keen eye for detail and a thorough review of the application form can prevent these common mistakes. It's always a good practice to double-check all filled-out information, ensure that all required sections are completed in full, and to review the form for accuracy before submission. Doing so not only aids in avoiding delays but also supports a more streamlined, efficient process for obtaining permission to conduct electrical work.

Documents used along the form

When working through the process of securing an electrical permit in Massachusetts, an applicant might encounter or require additional forms and documents to ensure compliance with local and state regulations. The complexity of electrical work, combined with the necessity to uphold safety standards, makes it imperative that every box is checked, metaphorically and literally. Here are ten commonly associated forms and documents that often accompany the Massachusetts Permit Electrical form, each serving a vital role in the comprehensive process of plan approval, inspection, and legal compliance.

  • Building Permit Application: This document is essential when the electrical work accompanies construction or significant renovation projects. It ensures that all construction meets local zoning and building codes.
  • Workers’ Compensation Insurance Affidavit: This affidavit is a declaration of workers' compensation insurance coverage for employees engaged in the electrical work, vital for compliance with state labor laws.
  • Owner’s Authorization Form: If the applicant is not the property owner, this form provides a declaration from the property owner authorizing the applicant to perform or oversee the electrical work.
  • Electrical Plan Review Submission Form: For complex projects, detailed electrical plans may need to be submitted for review before a permit is issued, ensuring that the proposed work complies with the Massachusetts Electrical Code.
  • Certificate of Insurance: Proof of liability insurance, including “completed operation” coverage or its equivalent, must be presented, unless waived by the owner, to safeguard against potential property damage or injury.
  • Notice of Start: Some local jurisdictions require notification when work is about to begin on a permitted project. This ensures that inspections are scheduled timely.
  • Request for Inspection: A form submitted to request a necessary inspection of the electrical work, ensuring it meets the Massachusetts Electrical Code requirements.
  • Utility Company Approval: For projects involving new services or major upgrades, approval or documentation from the utility company may be required to ensure the work is compatible with existing infrastructure.
  • Zoning Compliance Declaration: This document verifies that the electrical project complies with local zoning ordinances, which might dictate the types of work allowed in specific areas.
  • Final Completion Certificate: Once all electrical work is completed and inspections passed, a certificate may be issued to signify compliance with all codes and regulations, marking the project’s completion.

Navigating through permits and associated documentation can be daunting. However, understanding the role each form and document plays in the approval process can make navigating the legalities and technicalities a smoother, more manageable endeavor. Always remember to check with local authorities for any additional requirements specific to your area, as regulations can vary between jurisdictions. Completing and submitting all necessary paperwork diligently is not just about following the law; it’s a step toward ensuring the safety and integrity of electrical work for everyone involved.

Similar forms

The Massachusetts Permit Electrical form is similar to several other regulatory documents, each designed to ensure compliance with specific state codes and municipal requirements. These documents provide a structured way for professionals to submit necessary information to local authorities for review and approval, thereby facilitating the safe execution of various projects and operations that are critical to maintaining and improving infrastructure and living standards.

One such document is the Building Permit Application. Like the electrical permit form, the Building Permit Application requires detailed information about the project, including the location, the contractor's information, and specifics about the construction work to be done. Both forms serve as official requests for permission to commence with proposed projects, ensuring that they meet local and state regulations. The emphasis on specific details about the project, including the type of work and its estimated value, highlights the forms' role in maintaining standards and safety in construction and electrical works.

Another document with similarities is the Plumbing Permit Application. This form, much like the electrical permit, is necessary for any plumbing work that must meet specific codes, in this case, the Massachusetts Plumbing Code. Applicants must provide information regarding the project location, details of the plumbing work, and the licensed professional responsible for the execution of the work. The parallel between this and the electrical permit lies in their shared goal of ensuring public safety and compliance with state codes through systematic approval processes.

The Workers' Compensation Insurance Affidavit also shares common ground with the electrical permit form. While this affidavit specifically addresses insurance coverage requirements for workers, it similarly mandates accurate and truthful information provision under the penalty of perjury. Both documents are integral to a broader regulatory framework designed to safeguard the interests of workers, property owners, and the general public by ensuring that those undertaking the work are adequately insured and licensed, thus mitigating risks associated with construction and electrical projects.

Dos and Don'ts

When filling out the Massachusetts Permit Electrical form, certain practices should be followed to ensure the application process is smooth and complies with state requirements. Here are ten things one should and shouldn't do:

  • Do ensure all information is printed in ink or typed to maintain legibility.
  • Do check the box that accurately reflects your situation, such as if the permit is in conjunction with a building permit.
  • Do provide detailed information on the location and nature of the proposed electrical work, including all the required totals and types of installations.
  • Do include the estimated value of the electrical work if required by municipal policy.
  • Do sign the form certifying under the pains and penalties of perjury that the information provided is true and complete. This is crucial for the validity of your application.
  • Don't leave required fields blank. If something is not applicable, mark it accordingly, but ensure to address every field.
  • Don't forget to attach additional details or documents if desired by the Inspector of Wires or as required by the form instructions.
  • Don't overlook the workers' compensation insurance affidavit section. Ensure this is filled out accurately to avoid legal issues.
  • Don't fail to provide proof of liability insurance including “completed operation” coverage or its substantial equivalent, unless waived by the owner.
  • Don't underestimate the importance of checking the correct box regarding your status as an employer or the type of electrical work being performed. This information can have significant legal and insurance implications.

Misconceptions

When it comes to understanding the Massachusetts Permit Electrical form, several misconceptions often arise. It’s important to clear these up to navigate the permit process more effectively.

  • Misconception #1: The form is only necessary for major electrical work.

    This is not the case. Even smaller projects, such as adding outdoor lighting or updating a home’s electrical outlets, require submitting this form to ensure all work complies with the Massachusetts Electrical Code. This ensures safety and code compliance across all sizes of projects.

  • Misconception #2: Homeowners can’t apply for the permit themselves.

    While it is true that performing electrical work requires a certain level of expertise, homeowners can indeed apply for the permit, especially if they are doing the work themselves. However, they must comply with all local and state regulations, including proving their competence for the work planned.

  • Misconception #3: The permit is effective immediately upon application.

    In reality, the application process requires approval from the local Inspector of Wires. This means there is a waiting period between submitting the application and receiving permission to begin work. The inspector must review the planned work to ensure it meets all safety standards and regulations.

  • Misconception #4: Insurance coverage is optional for obtaining a permit.

    The form clearly states that unless waived by the owner, no permit for performing electrical work may issue unless the licensee provides proof of liability insurance, including "completed operation" coverage or its substantial equivalent. This requirement underscores the importance of having adequate protection against possible damages or accidents.

  • Misconception #5: The Workers’ Compensation Insurance Affidavit section is always mandatory.

    This section is not always required. For instance, if you are a homeowner doing all the work yourself or if the business is a partnership with no employees, then workers' compensation insurance is not required. The form offers checkboxes to indicate these exceptions, highlighting the varied requirements based on the applicant’s specific circumstances.

Understanding these misconceptions and the requirements of the Massachusetts Permit Electrical form can streamline the permit application process, ensuring legal compliance and safety for electrical work. It fosters a better relationship between homeowners, contractors, and local authorities by clarifying expectations and obligations.

Key takeaways

When preparing to file the Massachusetts Permit Electrical form, applicants must provide detailed information regarding their intended electrical work. This preparation ensures compliance with local regulations and promotes safety. Here are four key takeaways to guide you through the process:

  • Complete Information Is Crucial: All sections of the application should be filled out meticulously. Details such as the location of the work, types of installations (like number of luminaires, fans, or emergency lighting), and the estimated value of electrical work are required. This comprehensive approach helps the electrical inspector assess the scope and scale of the project accurately.
  • Insurance Coverage Is Required: Applicants must demonstrate proof of liability insurance, which includes "completed operation" coverage or its equivalent, unless this requirement is waived by the owner. This insurance protects against potential liabilities arising from the electrical work. Therefore, along with the permit application, proof of such insurance or an owner’s waiver of insurance must be submitted.
  • Understanding Workers’ Compensation Insurance Affidavit: The application includes a section for the Workers’ Compensation Insurance Affidavit, which is crucial for indicating the insurance status of employees involved in the project. Whether you’re an employer with multiple employees, a sole proprietor, or a homeowner doing work independently, you need to specify your situation. This clarifies your legal responsibilities and compliance with state laws relating to workers' compensation.
  • Signatures and Certification: The application must be signed and certified under the pains and penalties of perjury by both the licensee (or indicating exemption where applicable) and, in cases where liability insurance is waived, by the owner or the owner’s agent. These signatures are testament to the accuracy and completeness of all information provided in the application, affirming that the work will comply with the Massachusetts Electrical Code (MEC).

Understanding these key aspects of the Massachusetts Permit Electrical form ensures that applicants are well-prepared to navigate the permit process effectively, promoting safety and compliance in electrical work practices.

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