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BLDE-23-15959 permit
5/31/23,6:45 AM about:blank • ,. (Pb Commonwealth of Massachusetts ©�'Y.4z 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 0 Underground 0 No.of Meters: New Service Amps/Volts Overhead 0 Underground 0 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 0 No.of Devices: Swimming Pool: ln-Grnd.0 Above-Grnd.0 Hot Tub 0 No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3 0 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: GKOZ gtd.A1 1 bbt ood gel,u-a 400-) r iLL._ c- , 1/1 about:blank RECEIVED MAY[ ao 2 , `` 4In Official Use Only ,� �. , Permit No. l j.Z- ( a I 57 Vu DE PAR siwca atdFeeChecked =Y Oc ancy j,,UILDING : . • - . . 'EVENTION REGULATIONS [Rev. 1/07] heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical (MEC).527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFf RMATIONJ Date:, Ct�/ 3CJ/ ZCJZ3 City or Town of: ��r vviou4 i To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. � 6 Location(Street&Number) /S!6�2�/G. 1[00,,U/ )uf t, I o-f'vil o v it ` Owner or Tenant 554-0,.1-e Of -"Se e.s Al+ID�.`o Telephone No. . v.ZyO'e/90� Owner's Address Si A,A• Is this permit in conju with� a building permit? Yes 0 Non (Check Appropriate Box) Purpose of Building �*I( 'i CI 4 i (" Utility Authorization No. o — Existing Service e /00 Amps 1Z0I Volts Overhead �:4 Undgrd El No.of Meters •2 New Service Amps I Volts Overhead El Undgrd❑ No.of Meters ek Number of Feeders and Ampadty z C��. /� A Location and Nature of Proposed Electrical Work), L',),•re h i l- -fc,,.,,,.4, t/' ,,74 CI C ,,4_,z 4 I .E appr()y,rhaFe.ly 300 sioc✓•e -I-e-ef. v 1 Completion of die fblowing table may be waived by the!for of Wires. vs U. No.of Recessed Luminaires ty No.of Cell Fans No.of Total / - -� ) Transformers KVA �- KVA No.of Luminaire Outlets Z No.of Hot Tubs Generators 4 No.of Luminaires Swimming Pool Above ❑ In- 0 Pio.of Lmergency Lighting Brad. grnd. Battery Units --` No.of Receptacle Outlets 5- No.of Oil Burners FIRE ALARMS No.of Zones n No.of Switches No.of Gas Burners moo.Ifg tea, 1 ' No.of Ranges No.of Air Cond. Tndices ons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons _ KW — DN of�S n-Contained) No.of Dishwashers Space/Area Heating KW Local evices ❑ M� 0 Other No.of Dryers Heating Appliances KW SecNor of Devices D or Equivalent No.of Water KW No.ofigns BNaalaaf sts Data Wiring. Heaters Na of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP T cations WW No.ofor Ea �nt OTHER: �SOO p c) Attach additional detail if desired required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:�c,f 3 O 1 Z 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: INSURANCE 0 BOND 0 OTHER 0 (Specify:) I certify,under the and permiof ury,that the information on this application is true and complete. FIRM NAME: ✓t + l/I(i 5 I�.e,C-i C jrn✓\ J LIC.NO.: /0 C/ /. Licensee: 4. +' S �ce�-- G✓21 .. LIC.NO.:/Ut/3 9/3 (If applicable,enter"exempt"in t license tom) Bus.Tel.No.: 77/•¢,31e-0 IZg Address: /0 Sl,e i s toe Cots/,)c4,4c"w;`G�i , i� QZ 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 ', itytinsurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(c+- ", -4,.111 owner 0 owner's agent. Owner/Agent i Telephone No. ;,- 'ERMIT FEE:$ Signature 1 • The Commonwealth of Massachusetts _.1:7 �!/ Department of Industrial Accidents =::ie= 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. Aaalicant Information Please Print Legibly Name (Business/Organization/Individual): Sect,,t S C/e-cji",Lla v7 Address: /4 e,'-,ff 14 e City/State/Zip: s 501c1Wi r, A(A 7 Phone#: 77q- j 36 - 0/ze Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with / employees(full and/or part-time).* 7. ❑New construction 2.0 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 10uildingaddition 4.❑I 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 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. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§I(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. tContractors that thank 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. A l Insurance Company Name: /"G /14 14 r 0,0 Ge- j7ct t y — Policy#or Self-ins.Lic.#: NIT ( Expiration Date: y l 3 7Z0Z4( Job Site Address: I 5—(Z,✓1Q,✓ Kt City/State/Zip: s�U � Yar�avL, 44 oZ c Attach a copy of the workers'compensation policy declaration page(showing the policy numlltr and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishabl&y.a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDBOVid 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 penaltz°c of perjUry that the information provided above is tr a and correct. Signature: � /�"�, Date: Z Phone#: '7?z(-g36 O 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 S,kPlumbing Inspector 6.Other Contact Person: Phone#: