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Home My WebLink AboutBlde-21-005991 Commonwealth of Official Use Only Permit No. BLDE-21-005991 �E Massachusetts 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 INK OR TYPE ALL INFORMATION) Date:4/15/2021 City or Town of: YARMOUTH 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) 259 WILLOW ST Owner or Tenant MASS D.O.T. Telephone No. Owner's Address ! p A 1 S' 2-Z_ Is this permit in conjunction with a building permit? Yes 0 No 0 (C ''.:- Purpose of Building Utility Authorization N � µ Existing Service Amps Volts Overhead 0 Undgrd • -_ '�` ;_ New Service 60 Amps Volts Overhead 0 Undgrd El No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install two new services to MASS DOT Equipment sites. (AREA OF EXIT 7 RAMPS) 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 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.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 0 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: 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 0 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Michael P Mcdonald Licensee: Michael P Mcdonald Signature LIC.NO.: 16989 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:72 SHARP STREET UNIT C8, HINGHAM MA 020434364 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) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$200.00 c9, Sco lL_eL_ (j -fr 1 WcPeck A. nn / _ C�ommonwea/lh o/Massachiwells Official Use Only (/J�/J 1 = 1 +- t' Permit No. = 1 p 2eparlmenl ol3ire Service6 — �/ �- BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occu 1 07]ancy and Fee Checked .� (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: 3 -'�q a( City or Town of: V 4.1'✓hp d A Nl q- To the Inspector of Wires: By this application the undersigned gi/es np tice of his or her intention to perform the electrical work described below. Location(Street&Nu ber) IA) t l 0 .�� -�.j Q l4� j�- Owner or Tenant Jul(, Do-f Telephone No. lei-9 --(O/9j Owner's Address I 0r14- PI4-1 4- I30 1 s1 C Q Is this permit in conjunction with a building permit? Yes ❑ No C (Check Appropriate Box) J3a'e, Purpose of Building Utility Authorization No. 233 Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps i. Volts Overhead L,-------Undgrd Qr No.of Meters I Number of Feeders and Ampacity 3 dPP r Location and Nature of Proposed Electrical Wo n 3.erak- __, Fvr k.SS 0)� 1�e/YiL.D-� ILI- 4 Raw 1 NNo r,� 20 lv t-i-h ravna(,D los k a Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf T Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No. Initiatingon Detectionand Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices 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 Kam, 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: 3O o (When required by municipal policy.) Work to Start: c77 —d I 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 cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCEL BOND ❑ OTHER ❑ (Specify:) I certify,under the ins and penalties o perjury,that the information on this application is true and complete. FIRM NAME: Ldv/td1 � f LIC.NO.:3 iy� 4/ Licensee: �t 64144 A Gd Signature s v LIC.NO.: (If applicable,ent r "exempt VI m th license umber lime.) c� Bus.Tel.No.: %f3-��Q 7 � Address: , �. ,SF /u/t/i , 'i / Alt.Tel.No.: *Per M.G.L. c. 147,s.57-61,security work requires partment of Public Safety"S"License: Lic.No. ` 6,9d'r 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 Signature Telephone No. PERMIT FEE: $ ^ , ® DATE(MMIDD/ ( Q CERTIFICATE OF LIABILITY INSURANCE 4/7/2020YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER NAMEACT Barbara J LeBlanc Eastern Insurance Group LLC PHONE 508 923 2494 FAI�C,No):781-598-8445 1265 Belmont Street. (A/C.No.EMG Brockton MA 02301 ADDRESS:A BLeBlanc@EastemInsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Zurich American Insurance Comp 16535 INSURED 191730 INSURER B:North River Insurance Company 21105 McDonald Electrical Corp MEC Systems INSURER C:Tokio Marine Specialty Ins Co 72 Sharp Street-Unit C-8 INSURER D:National Union Fire Ins Co Hingham MA 02043-4364 INSURER E: New Hampshire Insurance co 23841 INSURER F: COVERAGES CERTIFICATE NUMBER:520908365 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MM/DDPOLICY/YYYY) (MM/EFF L D/YYYY) LIMITS ICY EXP LTR iNSD WVD D X COMMERCIAL GENERAL LIABILITY Y Y GL4693521 4/9/2020 3/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $300,000 X X,C,U MED EXP(Any one person) $25,000 X Blkt Contractual PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Deductible $0 E AUTOMOBILE LIABILITY Y Y CA5425649 4/9/2020 3/1/2021 COMBINED SINGLE LIMIT $ (Ea accident) 1,000.000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS OR X HIRED AUTOS X AUTOSWNED (Per acEc de!) DAMAGE $ X Hired physic al dam.(HPD) HPD coli/comp $ACV,$1,000 ded B X UMBRELLA LIAB X OCCUR Y Y 5811112872 4/9/2020 3/1/2021 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$0 $ D WORKERS COMPENSATION Y WC15852317 4/9/2020 3/1/2021 X MUTE EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution&Professional PPK1965525 4/9/2020 4/9/2021 Poll/Prof Limit 2,000,000 A Inland marine CPP4647716 4/9/2020 3/1/2021 Leased/Rented Equip 50,000 -Special Form Stored Materials 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Additional Insured status is provided for General Liability including Ongoing&Completed Operations per GL form's CG 20 10 04 13&CG 20 37 04 13, Automobile and Umbrella policies on a Primary and Non-Contributory basis as required by written contract.Umbrella is follow form.Waiver of Subrogation applies to all policies when required by written contract or agreement.Coverage is provided for stored materials up to$500,000 on a blanket location basis. Leased Rented Equipment included up to$50,000 any one item with$1000 Deductible for short term rental CERTIFICATE HOLDER CANCELLATION /y��1� �(� M CANCELLATION Town of rrweeeeti eya Il rV I' ' 1 ', SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE I CI14:214Q @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD