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Fill Your Massachusetts Permit Electrical Form

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.

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 #:_________________________________

Document Information

Fact Information
Governing Regulation Massachusetts Electrical Code (MEC), 527 CMR 12.00
Document Type Application for Permit to Perform Electrical Work
Required Mode of Submission All information must be printed in ink or typed
Connection to Other Permits Asks if the electrical work is in conjunction with a building permit
Details Required for Electrical Work Includes location, existing service specs, number of meters, and nature of proposed work among others
Insurance Requirement Proof of liability insurance including “completed operation” coverage or its substantial equivalent, unless waived
Legal Acknowledgment by Signatory Signatory certifies information accuracy under the pains and penalties of perjury
Workers’ Compensation Affidavit Indicates requirements depending on the applicant’s status as employer, sole proprietor, etc.

Guidelines on Filling in Massachusetts Permit Electrical

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.

  1. Start by writing the current Date at the top of the form where indicated.
  2. Enter the City or Town where the electrical work will be performed.
  3. In the section marked "To the Inspector of Wires," indicate your intention by stating that you are applying to perform the described electrical work.
  4. Fill in the location details under Location, including the Street & Number.
  5. Provide Owner or Tenant Telephone No., Owner’s Address, and check whether the permit is in conjunction with a building permit by marking Yes or No.
  6. Under Purpose of Building, mention the utility authorization number, and specify the existing service amps/volts. Indicate if the service is Overhead or Underground (Undgrd) and the number of meters involved.
  7. For new service installation, specify the Amps/Volts and also mention if it's Overhead or Undgrd, including the number of meters.
  8. In the section detailing the nature of proposed electrical work, fill in the relevant information regarding luminaires, fans, transformers, outlets, and any other equipment or fixtures being installed or modified, including the number of devices or equivalent measurements required.
  9. Estimate the Value of Electrical Work if required by municipal policy and mention when work is expected to start.
  10. Under INSURANCE COVERAGE, tick the appropriate box to indicate whether you have insurance, a bond, or if other, specify. Certify this information by entering the firm name, license number (or mark as "exempt"), and contact details.
  11. For the Owner’s Insurance Waiver, if applicable, the owner or the owner’s agent should sign, waiving the requirement for the licensee to have liability insurance.
  12. Fill in the PERMIT FEE section with the applicable fee and complete the telephone number field.
  13. In the Workers’ Compensation Insurance Affidavit section, print legibly the information required about the applicant. Check the appropriate boxes that describe your status, type of project, and fill out your workers’ compensation policy information if applicable. Attach a copy of the workers’ compensation policy declaration page as indicated.
  14. Sign and date the form at the bottom to certify under the pains and penalties of perjury that the information provided is true and correct.

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.

More About Massachusetts Permit Electrical

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.

Common mistakes

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:

  1. Not printing information legibly in ink or typing it. This may lead to misinterpretations of the information provided.

  2. 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.

  3. Omitting the telephone number and address of the owner or tenant. This contact information is essential for any necessary communication.

  4. Leaving the estimated value of electrical work blank when required by municipal policy. Providing an accurate estimate is critical for the assessment process.

  5. 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.

  6. Incorrectly filling out the insurance coverage information or not providing proof of liability insurance, which is a requirement unless waived by the owner.

  7. 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.

  8. 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.

Documents used along the form

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.

  • Workers’ Compensation Insurance Affidavit: This document verifies that the contractors performing the work have the necessary workers' compensation insurance. It's crucial for safeguarding the workers on site, affirming that they are covered under a policy that can provide benefits in case of work-related injuries or illnesses.
  • Building Permit Application: Often required for projects that extend beyond merely electrical work, this form indicates a broader scope of construction or renovation. Securing a building permit confirms that the overall project meets local zoning and building codes.
  • Proof of Liability Insurance: While the electrical permit application touches on insurance coverage, submitting detailed proof of liability insurance coverage is generally required. This demonstrates that the contractor can cover costs that may arise from accidents or damages incurred during the project.
  • Construction Supervisor License (CSL) (if applicable): For larger-scale projects involving structural work, a CSL may be required. This license ensures that the person overseeing the project is qualified and knowledgeable about Massachusetts building codes and safety practices.
  • Electrical Inspection Certificate: Upon completing the electrical work, an inspection by a qualified inspector is necessary to ensure that the work complies with the Massachusetts Electrical Code. The certification of this inspection is a critical document signifying that the project meets all required safety standards.

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.

Similar forms

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.

Dos and Don'ts

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:

  1. Print or type all information clearly in ink to avoid any misunderstandings or delays in processing.

  2. 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.

  3. 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.

  4. 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:

  1. 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.

  2. 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.

  3. 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.

  4. 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.

Misconceptions

  • 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.

Key takeaways

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.

  • Every applicant must provide detailed information about the proposed electrical work, including the location, owner or tenant details, and whether the permit is associated with a building permit.
  • The form requires specifics on the type of electrical work to be done, such as the number of recessed luminaires, ceiling-suspended fans, emergency lighting battery units, and more, to properly assess the scope and scale of the project.
  • It includes sections for both traditional and advanced electrical installations like fire alarms, security systems, telecommunications wiring, and even swimming pools, ensuring comprehensive coverage of potential electrical work.
  • Proof of liability insurance, including "completed operation" coverage or its equivalent, is mandatory unless waived by the owner. This requirement underscores the importance of accountability and protection for all parties involved in the electrical work.
  • A signature under the pains and penalties of perjury is required from the licensee, attesting to the truthfulness and completeness of the information provided. This emphasizes the legal seriousness of the form and the necessity for accuracy.
  • For those concerned with workers’ compensation insurance, the form includes an affidavit section that needs to be filled based on the applicant's employment status and the type of electrical project undertaken. This part aims at enforcing adherence to Massachusetts workers' compensation laws.
  • The application process also considers homeowner roles, granting them the ability to declare if they are performing all work themselves and thereby exempt from certain insurance requirements. However, if homeowners opt to hire contractors, a new affidavit must be submitted to reflect this change.
  • By requiring applicant information and a description of the electrical work planned, the form plays a critical role in ensuring safety, adherence to building codes, and protection against liabilities, benefiting both the property owners and the broader community.

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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