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Home My WebLink AboutElectrical Permit /BLDE-23-15959 - BLDE-23-15959 2101 5/31/23,6:45 AM about:blank �� ' Commonwealth of Massachusetts 01 . , * Town of Yarmouth ° ELECTRICAL PERMIT { Job Address: 15 GENEVA RD Unit: Owner Name: ALIBRIO JAMES J Owner's Address: 100 RANDOR STREET Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15959 Existing Service Amps/Volts Overhead ❑ Underground❑ No.of Meters: New Service Amps/Volts Overhead 0 Underground El No.of Meters: Description of Proposed Electrical Installation: Wiring for family room addition. No.of Receptacle Outlets: 5 No.of Switches: 5 Generator KW Rating: Type: No.Luminaires: 6 No.of Recessed Luminaires: 4 No.Wind Generators: Wind KW Rating: No.Appliances: KW: No.Water Heaters: KW: No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: No.Heat Pumps: Total KW: Total Tons: Fire Alarm System El No.of Devices: Swimming Pool: In-Grnd.El Above-Grnd.❑ Hot Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System El No.of Devices: No.Air Conditioners: Total Tons: Telecom System El No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System El No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount CI Ground-Mount❑ Level 1 El Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $ 1,500 Work to Start: May 30, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: SEAN G WILLIS License Number: 10439 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: EAST SANDWICH, MA, 025371365 EAST SANDWICH MA 025371365 Fee Paid: $75.00 Email: sgwilliselectrician@gmail.com Business Telephone: 774-836-0128 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. INSURANCE: \� Al)bt r Oil z AfC 4wrx) c (�(� 23 CNDt � ( 1 V*3 tock- 6-1-c•- i ( ‘,3,_._ 1/1 about:blank RECEIVED r MAY 30 2 ‘ ig ', `7 ynaddae d• Official Use Only ,.'.. • ., Permit No. � ,.1 ( a 1 57 I "WILDING DEPAR ` al c�7�Y ��` �� '; Y ------ r_ Occupancy and Fee Checked J •: •• - •• -EVENTION REGULATIONS [Rev, 1/07] (leave blank) APPLICATION FOR inPERMIT TO PERFORM ELECTRICAL WORK wor to be performed accordance with flee Mauachosetts Elecrical Cooddee(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF RMATTON) Date:,'"/Gty ?C ZGZ3 City or Town of: Ye- ✓i'00 n To the Inspector of Wires: below. 6 By this application the undersigned gives notice of his or her intention to perform the electrical work described 3 Location(Street&Number) /5—6eA e vo. bate( , .'uf 1, Yo,f-oi o u 744 'c Owner or Tenant 554-0A Of �c e s •4I'IOr'`o Telephone No. . C .Z4/0'41907 -� Owner's Address 3, A,A• Is this permit in conju with a building permit? Yes El No ] (Check Appropriate Box) c) Purpose of Building((ti k,1 /1 I F Utility Authorization No. ✓, Existing Service /0(0 Amps ZO/Z1-(0 Volts Overhead ti. Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters v,is Number of Feeders and Ampacity Z. )0c) A Location and Nature of Proposed Electrical Work: / r �//��/////�� it„�;' e �r71- .�,r'lY ITCX)c�v� cI. - L'f,�f11 o, appin y '0,7 a+e!Y 300 .S-c c,�.e. --e..e.fi. II ( Completion of the followingtabte my be waived by the l for of Wires. n lb No.of Recessed Luminaires No.of Cam- (I' k No.of Total Fans Z./ Transformers KVA No.of Luminaire Outlets 2 No.of Hot Tubs Generators KVA S��g Pool mid. ❑ In- ❑ No.of Emergency Lighting 4 No.of Luminaires grad. trod. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners 'No.of Detection and No.of Switches Initiating Devices nstal 1'' No.of Ranges No.of Air Cond. Too No.of Alerting Devices ined No.of Waste Heat Pump plumber Tons KW _ No.Det of ction/AlA�hg.DD Totals: it��l evices M Other Na of Dishwashers Space/Area Heating KW Local 0 Connection 0 No.of Dryers Heating Appliances KW SecNo.of Systems:* Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications No.Hydromassage Bathtubs No.of Motors Total HP D Wiring. Equivalent OTHER: I Attach additional detail irdesirvdia required by the Inspector of Wires. Estimated Value of Electrical Work: -L)00 (When required by municipal policy.) Work to Start:�c�,y 3 012 C 3 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: IN , NCEof 0 BOND 0 , THER that the 0 I cer , info n on this application is true and complete djy,under the andLIC.NO.: l 6!f�� FIRM NAME: ✓t -5 Lic";, ` ✓c Licensee: &4 V ,� _ Signatu LIC.NO.:/Ur/_3 9 B (If applicable,enter"exempt"in lie license pwnber lt'le.) 0� , Bus.Tel.No.: 77Y'9,3(' -0 IZe Address: /0 5L,e r.J/s ^e trots! .)ca,ic�w-,G141 4.'(� 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 '• ityansurance coverage normally required by law. By my signature below,I heby waive this requirement. I am the(ch '`, -1,■ owner ❑owner's agent.I Owner/Agent ! Telephone No. - 'ERMIT FEE:$ Signature ' The Commonwealth of Massachusetts -._, =ff1 Department of Industrial Accidents w =i��= a 1 Congress Street, Suite 100 Boston,MA 02114-2017 `t ti 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): -5ecc4 \&/ /t Elet Address: /0 City/State/Zip: s� dul�c�►, /�� CZ53 7 Phone#: 7-7y- S 3(a O/Ze Are you an employer?Check the appropriate box: v Type of project(required): I.C I am a employer with / employees(full and/or part time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on I will1 Q uilding,additiOn ensure that all contractors either have workers'compensationPly insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑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.t 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Arty 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. tContractors that mock 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. f n Insurance Company Name: /"G - t 1.15 j7C,sI,( Policy#or Self-ins.Lie.#: [y S/4 () Expiration Date: 1-1// t 3 /ZCZY Job Site Address: /5—(7e4P,✓0, City/State/Zip: C?o f , � ,,,,a , jM,4 Oz 6611 Attach a copy of the workers'compensation policy declaration page(showing the policy numbirr and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishabldy,a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDFicj 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 der the pains and penalties of perjury that the information provided above is tr e and correct Signature: fit/r Date: S" Z Zoe Phone#: '/q Q6 - o 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 53,Plumbing Inspector 6.Other Contact Person: Phone#: