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HomeMy WebLinkAboutBLDE-23-003439 • - Commonwealth of Official Use Only ‘1111Massachusetts Permit No. BLDE-23-003439 •' 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:12/21/2022 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) 13 BREWSTER RD Owner or Tenant DONAHUE ANNE M Telephone No. Owner's Address DONAHUE MARY E, 13 BREWSTER RD,WEST YARMOUTH, MA 02673 Is this permit in conjunction with a building permit? Yes ❑ 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 ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Sub-panel, new master bedroom/garage. 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 20 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 10 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: 12/07/2022 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•'rovides proof of liability insurance including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such cove ige 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: Robert E Baker Licensee: Robert E Baker Signature LIC.NO.: 12793 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address: 18 S HIGHLAND RD,PO BOX 99,N TRURO MA 026520099 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 /� ell— ��ov 4 `'Z/u°/?L riC44-r____ 2/(7 . nr77_____I Ernal ( Inswimc_f2 DECommanwaalth o� aeeachadaifeOfficial Use Only ar BUILDING Permit No, 2 33 3./3 9 sParlmsrcl ol}irs Jsrvccss i( � upn BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occ 1/0a7]cy and Fee Checked (leave blank) a n ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 0 All work to be performed in accordance with the Massachusetts Electrical Code( EC), 27 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: I o �I S dd- • City or Town of: YARMOUTH To the Inspecto of Wires: a' By this application the undersigned gives notice f his or her intention to perform the electrical work described below. Location(Street& umber) \ ( � ft Owner or Tenant V tA- ( ' .or 5�A).Q Telephone No. SG r'c7 - Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) ✓1 Purpose of Building 'Vi aS�,0..), S u, Qo el ,f d,,t Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd I I No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: o..�-e_tiC on Jew Sv�j Qar«,� V MaSi�S�Zi` + ��c« nCompletion of the followingtable may be waived by the Inspector of Wires. Cl No.of Recessed Luminaires No.of Cell:Sus No.of Total el p.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Ab-ove ❑ n- 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 1 No.of Detection and Initiating Devices III No.of Ranges �No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Hest utnp Number Tons KW 1No.of Se - outs ne Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local 0 a use c pa 0 Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.ofNo.of Devices or Equivalent Heaters ' No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Tetecommun cations Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of El trical Work: (When required by municipal policy.) Work to Start: \iP' ( ' a a. 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 ❑ BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties ofper,jury1 that the information on this application is true and complete, FIRM NAME: V..o .' %A , �.`eL,'C Co C'a. /] LIC.NO.: Licensee:l ice, '�� (jo„ Signature '"f"2._--=� 1 1 B� (If applicable,enter' cempt"i the lice numberlite.) LIC.NO.: c�1 Address: -1 1Q r r- VI mM a w ,-) CT.I.3� Bus.Tel.No.:Sam S71�9 3 Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Lic.No. 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 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ 2Iease visit our web site at http://www.mass.gov/dpi/boards/EL ROBERT E BAKER 77 SHORE DR PLYMOUTH,MA 02360-1370 (EL) Fold,Then Detach Along All Perforations ': _COMMONWEALTH OF MASSACHUSETTS. DIVISION OF OCCUPATIONAL LICENSURE BOARD OF ELECTRICIANS • ISSUES THE FOLLOWING LICENSE • REG JOURNEYMAN ELECTRICIAN • ROBERT E BAKER is 77`SHORE DR m= PLYMOUTH,MA 02360-1370 12793 B . 07/31/2025 275167 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER **"....44! a A��o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/15/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christian Barber,CIC NAME: The Oceanside Insurance Group PHONE (508)775-0500 FAX (508)790-7955 (A/C.No,Ext): (A/C,No): E-MAIL ADDRESS: 52 West Main Street INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: Mapfre 23876 INSURED Commerce INSURER B: 34754 Robert Baker DBA Robert Baker Electrician INSURER C: Hartford Insurance Company of the Midwest 37478 77 Shore Drive INSURER D: INSURER E: Plymouth MA 02360 INSURER F COVERAGES CERTIFICATE NUMBER: CL2292709243 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A 8008030014078 05/15/2022 05/15/2023 PERSONAL&ADVINJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC 40 , 00000 PRODUCTS-COMP/OPAGG $ , OTHER: XLEAD $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) _ BODILY INJURY(Per person) $ B OWNED SCHEDULED BCYX30 AUTOS ONLY X AUTOS 07/01/2022 07/01/2023 BODILY INJURY(Per accident) $ X HIRED 's/ NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) PIP-Basic $ 8,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE EORH C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N N/A 08WECAT5K8A 08/30/2022 08/30/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,and other limitations and endorsement of the policy. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This is to certify that the policies of insurance listed have been issued to the insured named above. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Rte 28 AUTHORIZED REPRESENTATIVE ...���yyy S Yarmouth MA 02664 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD