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Home My WebLink AboutBLDE-22-001699 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-001699 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•9/24/2021 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) 4 STRATFORD LN Owner or Tenant OBRIEN VIRGINIA C Telephone No. Owner's Address 4 STRATFORD LN,YARMOUTH PORT, MA 02675-1545 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring of addition. (Rough by others) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 4 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 7 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 4 No.of Gas Burners No.of Detection and Initiatine 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 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 Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent 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: 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. PERMIT FEE: $75.00 A- c wlV tef 6(: 35 //N COMMsrtwta h Of? aaaaee tits Official Use Only 34,0 servics6Permit No. ei2.....--(GW C BOARD OF FIRE PREVENTION REGULATIONS � � ' C' ': Check • l/t}7] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wart to be performed in accordiacc with the Massachusetts Electrical Code(MEC).527 CMR 121)0 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 9 )dc)_/a I City or Town of: y A s-re,o L>-r h 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) 9 6T C CA Y cos-c-) L tiJ L Owner or Tenant Telephone No. Owner's Address `S .n c. -i e i Is this permit in conjunction with s bei Wit? Yes No 0 (Check Appropriate Box) . Purpose of Building f we(.L:,Q ,....-1:r Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd ] No.of Meters New Service Amps 1 Volts fwd 0 Undgrd 0 No.of Meters Number of Feeders end,Amp ty Location Loand Nature of Proposed Electrical Work: (,);R;NQ or a n A d a' ri On he%once.-+ /h d-Se. c e - --i c.ra-cG , cJ contoletion of thefo lowi table nr,be waived by the hrctor of Wires. No.of Recessed ides y No.of Cel.-Sap (Paddle)Fans Tr rmers Kt No.of Lie Oatle. No.of Hot Tubs t3eaersit0rs KVA No.of Fres Pool Above •Q In' Q too.01 Ir rgency L ttag 3 ern& ern& Battery Units No.of Receptacle Outlets ''7 No.of 011 Burners FIRE ALARMS No.of Zones Na.of Switches I No.of Gas Burners 'Na.ofDetection andes I ki No.ofRanges No.of Air Cond. Total No.of Alerting Devices Tons No.o[Rrasts 1spssvis ,Number Toas ._._,.KW sR. nlorSelliCmer,ktrsostallikednevices No.of the s Space/Area Heating KW Local 0 C:ow a 0 other No.of Dryers Reeat ApPffitaces KW__ - N8.��or Equivalent No.of WBeaters "‘ater We.er Nu.eeth Debt Wiring' Sites Not of De;4ees or Tetecommuideations No.Hydromassage Bathtubs No.of Motors Total HP No.amnion es or Eeiluiv O MERz Attach additional detail IJdred or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by molliciPal Ply) Work to art; qr; {a I Inspections to be requested in accordance with I EC l 10,and upon completion. litiSUR14)+iClf Er Unless waived by the owner,no permit for the peribunance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent The undersigned catifpes that suchprage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE tgi ND 0 OTHER ❑ (Specify:) I centfp,: the pains andpetaldes ofper}ney,that ti(pelimon on fiat application It trite and complete. FIRM NAME: ; D 001 c Z €Lec-rr,c : LLC LIC.NO.: r,9 ix-7.3 A Licensee: n<ti,el E mi CL Sc.rc Sfgaatare eE ,n..S( o&P.e. u LIC.NO.: S16'Sa E (lfapplicablc enter+ ,.in the license number line.) _ # Bus.Tel.No.: 7$i AS 8 7170 Address: 6 6 ELK Ron M c f`1 i act L e 6 o r c P I A 0,9 3` Alt.Tel.No.: 'SSS$ A P? f318..5- *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. S S C O - 0 0 1 3 7 3 OWNER'S INSURANCE WAIVER:..I am aware that the Licensee does not hove the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner Q.owner's agent. ner/A , S OwTelephone No. I PERMIT FEE:$ 75- The Commonwealth of Massachusetts Department of Industrial Accidents =;ip 1 Congress Street, Suite 100 Boston, MA 02114-2017 ,:� www.mass aov/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): f (3,,DA 1 V- Le c-rr; c L L G Address: 6 E FLK Vt.)r OR City/State/Zip: 11 cue) Leharo /11A OP3y6 Phone#: 8 6 97 $1 85 Are you art employer?Check the appropriate box: Type of project(required): 1.21 am a employer with t employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'camp.insurance required.] 3. I am a homeowner doingall work myself t 9. ❑Demolition ❑ ys [No workers'comp.insurance required.} 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 1 �Buiiding addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance 13.Q Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGI,c. 1 4'0 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: I r a V e L e.r.S Policy#or Self-ins.Lic.#: L) 13 `j 6 a R 01 — I — `1 d Expiration Date: (, / 9 I Job Site Address: ' .5TrA dere) Lio City/State/Zip: `IAr,ro.iilh MA 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 jgnature: 013-0 „f`�, {,a,d.t4_ 3 lat. Date: �I.2 Phone#: �d R 6 7? R i S' 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#: