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Home My WebLink AboutBLDE-23-19348 BLD. A 8/16/23,2:43 PM about:blank Commonwealth of Massachusetts 80= yg ', *Ai Town of Yarmouth �� °r E 0 .r !e 6 w I;µY ELECTRICAL PERMIT - Job Address: 97 SOUTH SHORE DR Unit: Owner Name: OCEAN MIST LLC C/O NEWPORT HOTEL GROUP Owner's Address: 28 JACOME WAY Phone: Email: Purpose of Building Commercial Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19348 Existing Service Amps/Volts Overhead 0 Underground❑ No. of Meters: New Service Amps/Volts Overhead 0 Underground❑ No. of Meters: Description of Proposed Electrical Installation: Replace FACP&correct wiring following lightning strike. No.of Receptacle Outlets: No.of Switches: Generator KW Rating: Type: No. Luminaires: No.of Recessed Luminaires: 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❑ No.of Devices: Swimming Pool: In-Grnd.❑ Above-Grnd.❑ Hot Tub❑ No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: No.Gas Burners: Video System ❑ No.of Devices: No.Air Conditioners: Total Tons: Telecom System ❑ No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System ❑ No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount❑ Ground-Mount 0 Level 1 ❑ Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $ 1 Work to Start: August 16, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: GENE A CORMIER License Number: 1592 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: SOUTH DENNIS, MA, 026602667 SOUTH DENNIS MA 026602667 Fee Paid: $115.00 Email: sales@capecodalarm.com Business Telephone: 508-398-6316 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: c 640r--- J4 csi,,fir n4-1-3 (46- (SIL c) toP2r k 1/1 about:blank Commonwealth o/MaasacLiettd Official Use Only rfiiii7V- r E. --� 19 3i c� �7 Permit No.ao_ . )epartment o/.. ire�erviced Occupancy and Fee Checked � — BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] . (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 It F., (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: August 14, 2023 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. a Location(Street& Number)97 South Shore Drive Owner or Tenant Ocean Mist Hotel Building A Telephone No. Owner's Address 97 South Shore Drive South Yarmouth, MA 02664 Is this permit in conjunction with a building permit? Yes ❑ No ❑✓ (Check Appropriate Box) Purpose of Building Commercial Utility Authorization No. Existing Service Amps / Volts Overhead [1 Undgrd ri No.of Meters New Service Amps / Volts Overhead I I Undgrd ri No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replace panel and repair wiring issues Please FAX Permit& Permit# back-508-398-5666 or EMAIL - sales@capecodalarm.com Thank You 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 JNo.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices eii No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of Devices or Equivalent No.of No.of Heaters KW Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs INo.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: 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 l0 BOND 0 OTHER ❑ (Specify:) I certify,under thepains andpenalties operjury,that the information on this application is true and complete. Z .f 3 FIRM NAME: Cape Cod Alarm Co., Inc. � f/ri IC.NO.: 1592C O Licensee: GENE CORMIER Signature, /`� / l� (If applicable. enter "exempt"in the license number line.) NO.: Address: 204 OLD TOWNHOUSE ROAD WEST YARMOUTH, MA 02673 Bus.Tel.No.:508 398-6316 Tel.No.:800 *Per M.G.L.c. 147,s. 57-61,security work requires Department of Public Safety"S"License: Alt Lic.No. SS CO 002248 OWNER'S INSURANCE WAIVER: I am 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 the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ 115.00 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CAPE COD ALARM CO., INC. Address: 204 OLD TOWNHOUSE ROAD City/State/Zip:WEST YARMOUTH, MA 02673 Phone #: (508) 398-6316 Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with 30 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub contractors 2.0 i am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: Associated Employers Ins., Co. Policy#or Self-ins. Lic. #: WCC-500-5006433-2022A Expiration Date: September 1, 2023 Job Site Address: 97 South Shore Drive City/State/Zip:South Yarmouth Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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. g7 /41'2 Date: August 14, 2023 / Signature: � Phone#: (508) 398-6316 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 Phone#: Contact Person: