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Home My WebLink AboutBLDE-22-002722 uk�� Commonwealth of Official Use Only ' filti 4.4% Massachusetts Permit No. BLDE-22-002722 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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•11/10/2021 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) 23 SCALLOP RD Owner or Tenant SZCZUROWSKI ANDREW Telephone No. Owner's Address 298 BEACON ST#8, BOSTON, MA 02116 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service 200 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service&wiring of garage. 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. Ton l 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Eauivalent 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`thepains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: DANIEL E DICESARE Licensee: Daniel E Dicesare Signature LIC.NO.: 21275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 ELK RUN, MIDDLEBORO MA 023463065 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 my signature below,I hereby waive this requirement.I am the(check one) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $75.00 FeljeA4 6,A 44Gr:..,) ItIza 174 tee-, ,.1 NAL 07 1-1-7/1 . c,...p.tac ) owz m i N a2- ) RECEIVE D A. ,OV O 9 2011 , , 0/yyj l Official Use Only 1- ', la , ` } of o� ri++r. Permit No.e�— G�t2 toI tv- u� ARTNIEN Occupancy and Fee Checked `l ,� c s , •0 OF FIRE PREVENTION REGULATIONS • 110'771 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I I i jot I City or Town of: YAr rnoc� H, To the Imp actor of Wires: i By this application the undersigned gives notice of his or her intention to perforin the electrical work described below. Location(Street&Number) ,c1 3 S C et I L aP 11 D �' Owner or Teniat A N c3 re..,..) Telephone No. v owner's Address S am,t Is1this permit'in conjunction with s bonding permit? Yes W No 0 (Check Appropriate Box) Purpose of g .4 y Le Fa, t Y Utility Authorization Na. Existing Service /CO Amps' l/.20 /.2y6 Volts Overhead❑ Uadgrd,LSI No.of Meters New Service .200 Amps /3Q Qqo Volts d❑ Undgrd[I' No.of Meters Number of Feeders and Ampadty Loa ") Nat'l*ofd NatP reposed'Electrical Wore: Up j cn L L l ao g u n dor j r min A Sc r 4 l t: ro a s ooet 1 me \AI$ o. tin ;as'teickt 3orale 10; ri r le tic i;U (JAqq I Ce th,tokrevirtttabk!tr be wai*di byWu I of Wires. No.of Recened L res No.of CeL-Snap.(Paddle)Fans N°'+ t Transformers KVA eZt No.of Iumineire Outlets No.of Hot Tubs Generators KVA No.of Lumboaires pool Above ❑ In- ❑;No.Battery morning i g Sieg fid. grad, Vats No.of Reepta de Outlets No.of On Burners FIRE ALARMS No.of Zones No.of Swill*" No.of Gas Barren lNo. abdtiatinoliktedgmDevieesand 1 V No.of Ramses No.of Air Cond. T":i No.of Alerting Devices No.of HeatPomp,Number Tons KW ei arsdf a ed No.of Dishimsbers SpaadArea Heating KW Local 0 aullacIPILICoaaeedoa ❑ Other No,of Dryers Bead" Baca KW n,.....,. `4 , l�of 1�aor Etadvaieat No.of Water KW No.of leo.of ihia Beaters Sig Sonata . Na.'orDevkes or . No.Hydrems Bati►tdbs No.et Motors Total HP , hToi'afDe m' : , . OTHER Attach addiNoaal detail re aired or as required by the Inspector of Wires. Estimated Value of Work: (When required by municiIed Policy.) Work to Smart;. 4 inspections to be reed in sake with MEC Rule 10,and upon completion. NSUR4NCE E: tfnk;ss waived by the owner,no pe mit for the performance rmance of electrical work may issue unless the licensee perrvides goof of liability insurance including"completed operation"coverage omits substantial equivalent The ttndersignetl+ee:tifias bustsuch is in force,and has exhibited proof of same to the penult issuing office. I' CHECK ONE: INSURANCE I BOND 0 OTHER 0 (Specify:) I eert0,under the pains ander ofperjuly,that the information enMir appficatian is>aveand coespIat. FIRM NAME: D or„e -L e c-r sl c_ LLC LIC.NO. ia I a'7.5 A Licensor 17 a n;e L LT D i. Ce.sosc. signature iha,n4S eh;4'.e, .s LIC.PIG.: SI 6.521 E l f icabic este - ”in tiie liceare number tom) Bus.Tel.No.: ?e 1 R6 8 7 170 Address: ( l; Et K 1Rcsr t>c /"Ii as Le 6or'c J'IA Cc9346 Alt.Tel.No.: 'SO$ F,9'1 SIS3- 'Per M.G.L.c.147,s.57=61,security work requires Department of Public Safety"S"License: Lic.No. S SCO O 0 1 3 7 3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee doer not have the liability insurance coverage normally required by law. By my Signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Signature Telephone No. I PERMIT FEE: The Commonwealth of Massachusetts ►"_; + i Department of Industrial Accidents el= 1 Congress Street, Suite 100 Uri` {_- Boston,MA 02114-2017 ,ray www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): fl a(1 A += Le c i r; . L L C. Address: 6 6 ELK 'Rt..)r O R City/State/Zip: 1 c)s� Le_1n ac-c:. , 1 A O3V 6 Phone#: ..�0 8 6 7 7 S J 8 5" Are you an employer?Check the appropriate box: Type of project(required): 1.2/1 am a employer with Z employees(full and/or part-time).* 7. 0 New construction 2.01 am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself9. ❑Demolition yse [No workers'comp.insurance required.]t 4.DI am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[❑Electrical repairs or additions proprietors with no employees.. 12.0 Plumbing repairs or additions 5.1DI am a genera/contractor and I have hired the sub-contractors listed on'the attached sheet These sub-contractors have employees and have workers'comp.insurance.; 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -T—f o.. V e Ler.c Policy#or Self-ins.Lic.#: OR -- 1 3 9 ! R 01 - I`i — a Expiration Date: (,/ 9 / a a 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 MGL c. 152,§25A is a criminal violation punishable by 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.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: c&Q. < ; t ,d.t` Date: Phone#: _ 5 d g 6y7 ' I g{ 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#: