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Home My WebLink AboutBLDE-24-132 1/26/24,6:26 AM about:blank Commonwealth of Massachusetts og4 �4 * Town of Yarmouth �'� 0 ELECTRICAL PERMIT � M � �1' Job Address: 53 WEST YARMOUTH RD Unit: Owner Name: CARVALHO ANTONIO CARVALHO MARIA S Owner's Address: 90 ANNIE MOORE RD Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-132 Existing Service Amps/Volts Overhead ❑ Underground❑ No. of Meters: New Service Amps/Volts Overhead❑ Underground❑ No. of Meters: Description of Proposed Electrical Installation: Septic pump&alarm. 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: ln-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❑ Level 1 ❑ Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $ 1,200 Work to Start: January 26, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: BRIAN A SMITH License Number: 24307 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: BARNSTABLE, MA, 026301503 BARNSTABLE MA 026301503 Fee Paid: $50.00 Email: briansmithelectrician@gmail.com Business Telephone: 508-737-8679 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: q140fritt 1/1 about:blank 00i, U _ _ Comnwnwealth.el'/aedachuaafh Official Use Only �. ,� ' ' Apartment -� cc77 Permit No, f Z` —� 3 Z ark Y 2)epartms 1 o� }ire�ervicea '. (i 4 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( C),527 CMR 12.00 �1 (PLEASE PRINT IN INK OR TYP ALL INFORM4TION) Date: i 5/94 a�'� City or Town of: 1j 'jl7v v 77—I To the Inspector of Wires: j By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ,5 f `,� 7 Owner or Tenant / 7),'\/7 C- , i ��i6 Telephone No.SC rr '17 7.... .)-6 ,).1)(! Owner's Address ,9971)," 1 Is this permit in conjunction with a building permit? Yes E. No Cie (Check Appropriate Box) Purpose of Building Utility uthorization No. Existing Service /O Amps /Jo/zVo Volts Overhead Undgrd n No.of Meters / New Service Amps / Volts Overhead n Undgrd E No.of Meters *1 Number of Feeders and Ampacity liLocation and Nature of Proposed Electrical Work: /4)/k'//v4- Lf-7. /v<�fr j >.�%/C t5 -//-=/ -7 Ni kil Completion of the followingiable may be waived by the Inspector of Wires. Total W No.of Recessed Luminaires No.of Ceil.-Susp. Transformers KVA nNo.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 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 AlertingDevices 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❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KWSecurity Systems:* No.of Ibevices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or wvagglent No. Hydromassage Bathtubs No.of Motors / Total HP i/� Telecommunications No.of Devices or Equivalent E OTHER: nl Attach additional detail if desired,or as required by, rr toll�jWirea. Estimated Value of Electrical Work: /0/C� C'U (When required by municipal policy.) l tur[[`t Work to Start: Inspections to be requested in accordance with MEC Rule 10,an +„, ic1n. Ri e � 1��r INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of ele+trioal wotkmay issue unless_ the licensee provides proof of liability insurance including"completed operation"coverage or its substantiarequivalent.The undersigned certifies that such cover a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE t BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalfies of perjuty,that the information on this application is true and complete. FIRM NAME: ,f'--7, ,)'// ' LIC.NO.: 36 7 Licensee: 50-774 Signature <--- LIC.NO.: (If applicable,enter "e mp "in the license numbe line.) Bus.Tel.No.. l" I15 CMG t .t 7 rr� Address: A&N 1 O "/e , i�5 f 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 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. PERMIT FEE: $ • The Commonwealth of Massachusetts I — Department of Industrial Accidents k=vfor= 1 Congress Street, Suite 100 l;E= ' 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): xg, 7.„ , j77/ /X( Address: 070 ,•,�,d,'j(..G City/State/Zip: i i(/,0� �/ ,7 ) Phone #: j-2 g- 73-7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I employer with employees(full and/or part-time).* 7. ❑New construction 2 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. I am a homeowner doingall work myself. t 9. ❑ Demolition ❑ y [No workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on mYproperty. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. ectrical 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.t 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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. 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. ��//��jj Insurance Company Name: lilt•,��/� /%/l1l UA//jt)(1 Policy#or Self-ins.Lic.#: ,1:0/3 jZ) Expiration Date: </`//r- Job Site Address: City/State/Zip: y 9 J777/ 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. I do hereby certify u e pains penalties of perjury that the information provided above is true and correct. Signature: Date: ,�j�04%;? Phone#: f 7 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: