The URL can be used to link to this page

Home My WebLink AboutBLDE-24-55 1/12/24, 1:16 PM r about:blank Commonwealth of Massachusetts v v� ,, * Town of Yarmouth , , sio � t , C ELECTRICAL PERMIT # �: � Job Address: 2 FIRST RD Unit: Owner Name: CARROLL DANIEL CARROLL MAUREEN Owner's Address: 20 MORNINGSIDE DR Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-55 Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters: New Service Amps/Volts Overhead ❑ Underground❑ No. of Meters: Description of Proposed Electrical Installation: General wiring on porch. No.of Receptacle Outlets: 3 No.of Switches: 2 Generator KW Rating: Type: No. Luminaires: 2 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❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 3,000 Work to Start: January 12, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: CHRISTOPHER CREAM License Number: 57825 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: ABINGTON, MA, 02351 ABINGTON MA 02351 Fee Paid: $75.00 Email: c.cream1993@gmail.com Business Telephone: 508-685-3547 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: auatt / ( 7 e F-6r )11C) C- 7 1474 about:blank 1/1 C. cfe /993�Go,;/L-ceit/ ` Commonwea&tk o/Maaeackueat eta!Use Only ccyy�� 1 Permit No. 2 eL)epartment ol3ire Sereicee a a Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS )Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be nerfarmed in accordance with the Massachusetts Electrical Code(MEC).527 CMR 12.00 iLLEASE PRINT IN INK OR TYPE 4LL INFORMATION) Date: I ,Z I Z`j City or Town of: ,Ur nn pkA. '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) 9 1. Si- (00, 1 Owner or,Tenant Q Ct i , a N ( C.V'r 0 t I , Telephone'No. 6 (-9-—51.4 6 ~- 6)',III Owner's Address , I.5' rye,,d 14r vi eu fi ' Ai A r Is this permit in conjunction with a building permit? Yes I 'j No I I (Check Appropriate Box) Purpose of Building 0'vJ G II; ,a r) Utility Authorization No. Existing Service 'ZOU Amps I to / 'LW Volts Overhead R Undgrd P No.of Meters I /'� - ..New Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters 0 t- 'Number of Feeders and Ampacity z I1.4 V I Location and Nature of Proposed Electrical Work: ' IC.-0 — 5 CO era r (Ai,T ek S Q Completion of the following_table may be waived by the Inspector of Fore. 1` 0 I No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans f No.of 1 otal � Transformers KVA 0 No.of Luminaire Outlets No.of Hot Tubs Generators KVA '� "� Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units ce m. No.of Receptacle Outlets 3 INo.of Oil Burners FIRE ALARMS INo.of Zones No.of Switches 2 INo.of Gas Burners 'No.of Detection and Initiating Devices • No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices . 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 L. Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent 1No.of Water Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of'Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent IOTHER: Attach additional detail if desired,or as required by the Inspector of f Wires. Estimated Value of Electrical Work0 3, o o0. (When required by municipal policy.) Work to Start: I I i L./ Z.y 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 a BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: C, `�'�, ;S L, t' reo I'VN Signature �(./-„ -_ C---,-- LIC.NO.:S s 13 llf applicable,enter -exempt"in the license number C Address: ( }Z oat s` S •, f/n0/A/6TON m9, 403 s Alt./ But.Tel No.: 5-0 A i�4 `- 3Sy *Per M.G.L.c. 147.s.57-61,security work requires Department of Public Safety"S"License: Lie.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)0 owner ❑owner's agent. Owner/Agent signature Telephone No. 1 PERMIT FEE:$ j _ f The Commonwealth of Massachusetts Department of Industrial Accidents =' � 1I Congress Street, Suite 100 �' j= 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/Organizatiorrflndividual'l (, , C Yea vv-, F it?L{-t.i Lt'eto Address: I -3" .. Oct IL- j-t-, City/State/Zip:' l b i) ,") I AA- c> :3_% Phone*: 50 Q — ii -3.5y 7 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.21 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. Remodeling 9. ❑Demolition 3.0 I sin a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my pro 10 [ '$wilding addition ensure that all contractors either have workers'compensation insurance or are sole l w111 proprietors with no employees. 11.[]Electrical repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.: 13. Roof repairs b.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 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. 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 fob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 t ▪ coverage verification. I do hereby certifir under the pains and penalties ti 1 perjury that r pena`ie o perjury that the information provided above is true and correct. CSignature: Date: 1 j Z.. 2- Phone#: cU e -- b b -. 3.5-y' 2 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 b.Other Contact Person: Phone#: