The Massachusetts Permit Electrical form is a crucial document for anyone planning to undertake electrical work within the state. It serves as an application to the Department of Fire Services' Board of Fire Prevention Regulations, detailing the scope of work and ensuring compliance with the Massachusetts Electrical Code (MEC). With sections covering everything from the nature of the electrical work to worker's compensation insurance, this form is comprehensive and mandatory for electrical project approvals. To streamline your electrical work application process, click the button below to fill out the form.
In the landscape of construction and renovation, the Massachusetts Permit Electrical form stands as a pivotal documentation required for the lawful execution of electrical work within the Commonwealth. Managed by the Department of Fire Services’ Board of Fire Prevention Regulations, this crucial form serves not only as a blueprint for the proposed electrical assignments but also ensures adherence to the Massachusetts Electrical Code (MEC), 527 CMR 12.00. From residential lighting installations to comprehensive wiring for new construction projects, the application facilitates a broad spectrum of electrical undertakings. Applicants are mandated to provide distinct details encompassing the project's scope—ranging from the installation of recessed luminaires and emergency lighting to the comprehensive estimations of the electrical work's value. Moreover, this form intricately ties into the broader framework of construction regulation by necessitating concurrent compliance with workers’ compensation insurance requirements, thereby underlining the inherent emphasis on safety and accountability. In essence, this form not only articulates the technical specifics required for electrical work permissions but also embeds a layer of protection for workers, property owners, and the electrical integrity of buildings within Massachusetts.
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
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
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.
No. of Alerting Devices
Tons
No. of Waste Disposers
Heat Pump Number
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
Security Systems:*
No. of Devices or Equivalent
No. of Water
Data Wiring:
Heaters
Signs
Ballasts
No. Hydromassage Bathtubs
No. of Motors
Total HP
Telecommunications Wiring:
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
(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: $
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 #:_________________________________
Filling out the Massachusetts Permit Electrical form is a requisite process for ensuring that all electrical work complies with the Massachusetts Electrical Code (MEC). This detailed submission is crucial for obtaining the necessary approval before undertaking electrical installations or modifications. The following steps are designed to guide you through filling out the form correctly to ensure a smooth and successful application process.
After completing these steps, review the filled form for accuracy and completeness. Once verified, submit the form to the appropriate municipal office, either in person or as directed by the city or town’s guidelines. Remember, obtaining this permit is a step toward ensuring that all electrical work is conducted safely, in line with the Massachusetts Electrical Code (MEC), and is duly inspected and approved by the local Inspector of Wires.
What is the Massachusetts Permit Electrical form used for?
The Massachusetts Permit Electrical form is used to apply for permission to perform electrical work in the Commonwealth of Massachusetts. It is a formal notification to the local Inspector of Wires of the applicant's intent to undertake electrical installations or modifications according to the Massachusetts Electrical Code (MEC), 527 CMR 12.00.
Who needs to fill out this form?
Any individual or firm planning to perform electrical work in Massachusetts, whether it's new installations, repairs, alterations, or extensions, must fill out this form. This includes licensed electricians and contractors, as well as homeowners performing their own electrical work in some cases.
Is insurance required to obtain an electrical permit in Massachusetts?
Yes, unless waived by the owner, proof of liability insurance with "completed operation" coverage or its substantial equivalent is required for the issuance of an electrical permit. This ensures that the licensee is covered for any incidents that may occur as a result of the electrical work performed.
Can a homeowner waive the liability insurance requirement?
Yes, a homeowner can waive the liability insurance requirement by signing the owner's insurance waiver section of the form. By doing so, the homeowner acknowledges that the licensee does not have the normally required liability insurance coverage.
What does 'estimated value of electrical work' mean on the form?
The 'estimated value of electrical work' refers to the total cost of the electrical project, including materials and labor. This estimation is used for municipal policy purposes and may influence the permit fee.
What is the Workers’ Compensation Insurance Affidavit section?
This section requires applicants to declare their workers' compensation insurance status. It ensures compliance with Massachusetts law, requiring employers to provide workers’ compensation insurance for their employees. This section is crucial for confirming that the project adheres to legal standards for worker protection.
What happens if I start work without a permit?
Starting electrical work without a permit is against the law and may result in fines, the requirement to remove or redo the work, and possible liability for accidents or damages. It's important to obtain all necessary permits before commencing work to ensure safety and compliance with Massachusetts regulations.
How do I submit this form?
This form must be submitted to the local Inspector of Wires in the city or town where the electrical work will be performed. Submission requirements may vary, so it's advisable to contact the local department for guidance on submission methods and any additional documents that may be required.
Is it possible to perform electrical work myself as a homeowner?
In some cases, homeowners may perform electrical work on their own properties without being a licensed electrician. However, they are still required to fill out the Massachusetts Permit Electrical form and obtain the necessary permits. It's important to check local regulations and possibly consult with the local Inspector of Wires before starting any DIY electrical projects.
What should I do if my electrical work requires inspections?
Electrical work often requires inspections to ensure compliance with the Massachusetts Electrical Code. The form mentions that inspections should be requested in accordance with MEC Rule 10, and upon completion. After submitting your permit application, you should arrange for any required inspections with the local Inspector of Wires at various stages of your project and upon its completion.
When filling out the Massachusetts Permit Electrical form, individuals often make a variety of mistakes that can delay the process. Understanding these common errors can help ensure that your application is filled out correctly and efficiently. Here are eight common mistakes:
Not printing information legibly in ink or typing it. This may lead to misinterpretations of the information provided.
Failing to check the appropriate box indicating whether the permit is in conjunction with a building permit. This detail is crucial for the processing of the application.
Omitting the telephone number and address of the owner or tenant. This contact information is essential for any necessary communication.
Leaving the estimated value of electrical work blank when required by municipal policy. Providing an accurate estimate is critical for the assessment process.
Not specifying the type of work (e.g., new construction, remodeling, electrical repairs) in the Workers’ Compensation Insurance Affidavit section. This information helps in understanding the scope of the project.
Incorrectly filling out the insurance coverage information or not providing proof of liability insurance, which is a requirement unless waived by the owner.
Forgetting to sign the application or having missing signatures, such as in the owner’s insurance waiver section or the bottom of the Workers’ Compensation Insurance Affidavit.
Not attaching additional details or sheets as required for the Inspector of Wires or when listing subcontractors and their workers' comp policy information. This oversight can lead to incomplete submissions.
Becoming aware of these common pitfalls can greatly enhance the accuracy and completeness of your application, facilitating a smoother permit issuance process.
When embarking on electrical work in Massachusetts, the Massachusetts Permit Electrical form is integral. However, to ensure a comprehensive approach and adherence to legal and safety standards, several other documents and forms often accompany it. These additional documents play a pivotal role in streamlining the permit application process, enhancing project transparency, and ensuring compliance with state regulations.
Together, these documents complement the Massachusetts Permit Electrical form, each serving a unique purpose in the permit application and compliance process. Collectively, they ensure that electrical work is conducted safely, responsibly, and in alignment with Massachusetts's regulatory requirements. This holistic documentation approach helps protect the property owner, workers, and the broader community by emphasizing safety, legality, and quality in electrical projects.
The Massachusetts Permit Electrical form bears similarities with other regulatory documents used across various states and municipalities in the United States, specifically those that pertain to the application process for construction, renovation, or electrical work permits. These documents, while tailored to their specific jurisdictions or sectors, share commonalities in structure, purpose, and content with the Massachusetts Permit Electrical form.
One document similar to the Massachusetts Permit Electrical form is the Building Permit Application commonly used by city or county building departments. This application, like the electrical permit form, requires detailed information about the property in question, the nature of the work to be performed, and identification of the parties responsible for the work, including owners and contractors. Both forms typically ask for specifics about the project, such as location, project description, estimated cost, and contractor licensing information. Additionally, they both may require signatures certifying that the information provided is accurate and that the work will comply with current building codes and standards.
Another document that shares similarities is the Workers’ Compensation Insurance Affiliation as seen within the Massachusetts Permit Electrical form. Many states and municipalities require proof of workers' compensation insurance for contractors performing work on properties. This affidavit or a section within a permit application aims to ensure that contractors carry the necessary insurance to cover their employees in case of injuries on the job. The document typically lists the employer or company name, the insurance carrier, policy number, and expiration date, similar to the insurance verification section found in the electrical permit form. This parallels not only in content but in the document’s intent to protect homeowners and workers by enforcing regulatory compliance.
Filling out the Massachusetts Permit Electrical form is a critical step in ensuring that electrical work is carried out safely, legally, and in accordance with state regulations. Here are four things you should do, along with four things you shouldn't do, when completing this form:
Do:
Print or type all information clearly in ink to avoid any misunderstandings or delays in processing.
Ensure that every section of the application is completed accurately, providing detailed information about the proposed electrical work to facilitate a smooth review and approval process.
Include proof of liability insurance with "completed operation" coverage, as this is mandatory unless waived by the owner. This insurance protects both the homeowner and the electrician in the event of unforeseen accidents or damage.
Sign and date the form to certify under the pains and penalties of perjury that the information provided is true and complete. This legal acknowledgment is crucial for the validity of your application.
Don't:
Leave any sections blank unless specified by the Inspector of Wires or if the section clearly does not apply to your situation. Incompleteness can result in processing delays or a denial of the permit application.
Forget to check whether this permit is in conjunction with a building permit, as this information is important for understanding the full scope of the project.
Omit the estimated value of the electrical work if it is required by municipal policy. Providing an accurate estimate is important for record-keeping and may influence the permit fee.
Fail to request inspections in accordance with MEC Rule 10, and upon completion of the work, as inspections are essential to ensure the electrical work meets all safety standards and code requirements.
By following these guidelines, applicants can improve the likelihood of a smooth and successful permit application process.
One common misconception is that the Massachusetts Permit Electrical form is only for licensed electricians. In reality, the form requires anyone performing electrical work, including homeowners working on their own property, to submit an application, ensuring all work complies with the Massachusetts Electrical Code (MEC).
Many believe this form is just for major electrical work. However, it encompasses a wide range of electrical installations and repairs, including adding outlets, light fixtures, or updating existing systems. The detailed section requesting information about the work scope illustrates the form's broad application.
Another misconception is that the insurance requirement can be casually overlooked. The form mandates proof of liability insurance unless waived by the owner, underscoring the importance of having proper coverage for electrical work performance or facing potential legal repercussions.
It's incorrectly assumed that submitting the electrical permit form is the final step. Submitting the form is only the beginning; inspections are required as outlined by the MEC rule 10, emphasizing ongoing compliance and work quality throughout the project.
Some people think the Workers’ Compensation Insurance Affidavit section is optional for all applicants. This portion must be completed to show compliance with state laws regarding workers’ compensation insurance, only excluding those in specific categories such as homeowners doing all work themselves.
There's also a misconception that if working under a general contractor, individual workers or subcontractors don't need to worry about this form. Yet, the form requires information on all subcontractors, including their workers’ comp. insurance, highlighting the responsibility of all parties involved in electrical work to comply.
Many assume that once the electrical permit is granted, any changes or additions to the project do not require notification or approval. Any modifications to the original plan submitted require informing the Inspector of Wires, to ensure all work remains up to standard.
Lastly, a common misunderstanding is that the permit application process is overly bureaucratic and time-consuming. The form is straightforward and designed to ensure safety and compliance with state regulations. Timely submission and accurate completion can streamline the process significantly.
When intending to conduct electrical work in Massachusetts, it's necessary to submit an Application for Permit to Perform Electrical Work to the local Inspector of Wires. This form is crucial for ensuring that electrical work complies with the Massachusetts Electrical Code (MEC), as stipulated by the Board of Fire Prevention Regulations.
Completing and submitting the Massachusetts Permit Electrical form diligently is essential for compliance with state regulations, securing the necessary permissions, and ensuring the safety and success of electrical projects within the state.
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