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Home My WebLink AboutBLDE-23-003582 o'...' Commonwealth of Official Use Only M, Massachusetts Permit No. BLDE-23-003582 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:12/31/2022 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) 32 DAVIS RD Owner or Tenant WOLFGRAM ALVIN G Telephone No. Owner's Address P 0 BOX 863, ESSEX, CT 06426-0863 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 ❑ 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: Install generator 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 1 KVA 20 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 0 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 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: 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 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 CI owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$50.00 I ' IZIa, emussonweasa a►/riaesachaasd li Official Use Only 1- x= , s,_ {y, 0P 1-No. . -�i '3S63Z (. % ..G. /town ! ..✓. o ' Occupancy and Fee Checked r ° BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07) leave bleak [ ° APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in acconia ce with the Massachusetts Electrical Code(MEC).527 CMR 12.00 (PLEASE?MT IN INK OR TYPE ALL INFORMATION) Date: /a I,?/aa City or Town of: fo r,►to.rri1 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) • J a.o;4 t2 t Owner or Tenant A Lv;r► Wol �r-a..•� Telephone No. y Owner's Address Sam Is this permit la conjunction with*building permit? Yes 0 No [1� (Check Appropriate Box) (il P.urpoae of BaBding .,S+o Le.- Fa.n%v L Y 'p 4,c.c c,h,9 Utility Authorization No. E Service Amps i Volts Overhead Ej Undgrd U Na.of Meters New Sere AMPS I Volts Overtead 0 Undgrd 0 No.of Meters Number of Feeders and,Angsadty Lecithin'ami Nature of Proposed Eketrical Work: W. R�,.,3 off" c. do K�., s-ra•,ab r Cre. cr r i1,% oc a.r.p wt!,or~. os,s. Trae.sc..r' .c i,�i-rck ris Onnoletian af'tiej AIowrrtjtabk may be waived by the I ector of Wines. No.of R Laminaires No.of Cell-Sup.(Paddle)Fans. Total No farmers KVA SZ No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of S Pool'Above 0 In- ❑ No.of 5.mergeecy Luting zr8d. 1 �> Usdts No.of Receptacle Outlets No.of 011 Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners "No.I ankwell Devandices . No.of Ramses No.of Air Cond. Toonnsi No.of Aug Devices No.er Waste Disposersat Tgatin Number Tons .._.KW "*De Self-Contained No.of DiskwashersSpace/Area Heating KW . Local 0 MIIIKIP130 Other Connection No.of Dryers K�W -Security +* Note o f or Emdvaiemt rte.of Wader Ifvfr No.of No.of W Heaters — gigs Baltasta New oaf Devices or No.wor000solop1Nu.011ifOtent TOUR HP [" No.eiDavkes or Eltufv 'OTHER: Attach additional detail Vdestrod or as nsa tiro d by the Inspector af';n es. Estimated Value of Electrical Work: (When required by municipal policy.) Wort to Start:. Inspections to be requested in accordonce with MC Rule:10,and upon completion. INSURANCE Ct t CAGE: Unkss waived by the owner,no permit for the performance of electrical trical work may issue unless the licensee provides proof of liability insurance including"mod operation"coverage or its substantial equivalent The undersigned oasts that such eir.yeage is in force and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ND 0 OTHER 0 (Specify:) I certify,under the pains ands ofpeijary,that the Infitrosation on this application es tree and complete. FIR NAME: ,D o.r t E.L e c-r r-,c LL C LIC.NO.: a I a1'1:5 i 1)oa(NI e.L. i_ 1:1 i Cc.Bare Stare cl r ..Q ,2e P.e� .. LIC.NO.: SI 6' 0,E if icabta a '"fit"in the license n Wnber lino Biro.Tel.Ne.: ?$i '6 8 '1 170 Address: 66 ELK Ran Pit- CAI c e$Le bare JMA Ci 3 4 6 Aft.Tel.No. 50 a A9'7 818.E *Per M.G.L.c. 147,s.5741,security work requires Department of Public Safety"5"License: Lie.No. ..S S CO 0 Q 1 3 7 3 OWNER'S INSURANCE WAIVER: I men 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 rite(check one)0 Ownef 0 owner's agent, OwnertAgent SivtatureTelephone No, 1 PE IT FEE:X 0 0.0 Z. The Commonwealth of Massachusetts ti 8.mt _ Department of Industrial Accidents 1 Congress Street, Suite 100 =« , Boston,MA 02114-2017 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): f a n g 1-7 c i S-; C L L C. Address: ao 6 F L K 'R r, D R City/State/Zip: Pri cCci � e1,)aro /''IA O)3y6 Phone#: 3 CS 3 6 9? $_/ Are you an employer?Check the appropriate box: Type of project(required): 1. /1 am a employer with 3. employees(full and/or part-time).* 7, ❑New construction 2.n 1 am a sole proprietor or partnership and have no employees working for me in • 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself[No workers'camp.insurance required.] 10 ❑Building addition 4.0I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.El Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance? 14.0 �~ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. Other 1rc►rcra'co.r 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. lithe 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: —Fr Policy#or Self-ins.Lie.#: L) I ZV 9 Fi 1 R O 1 ' /9 - Expiration Date: (7 1 Ct / e Job Site Address: 30l Dr.ul, l 'O City/State/Zip: 7LL,ryno arks 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. . L I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: oElCurtug 1 ' (z�-t� Date: )2//4 /aa Phone#: ' 677 8I g Official use only. boltikly.riteiin 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#: _ I