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Home My WebLink AboutBLDE-23-003512 Commonwealth of OfficialUseOnly 4 , of r1 Permit No. BLDE-23-003512 Massachusetts `*..' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/071 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:12/28/2022 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) 50 TASMANIA DR Owner or Tenant GILLIS MARCIA A TR Telephone No. Owner's Address MARCIA A GILLIS LVG TRUST, 50 TASMANIA DR,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd Meters New Service Amps Volts Overhead 0 Undgrd o ers Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wire ductless AC and water heater. p /r ,_ i Completion of the following table coat, 'v ‘ '.' t nspector of Wires. 41* No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KA No.of Luminaire Outlets No.of Hot Tubs Generators KVAV No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting gods( 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 Initiatine 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/Alertine Devices No.of Dishwashers Space/Area Heating KW Local ❑ 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 Siens 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: 12/23/2022 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 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 pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: CHARLES K SWANSON Licensee: Charles K Swanson Signature LIC.NO.: 12895 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:718 CEDAR ST,W BARNSTABLE MA 026681300 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: $50.00 • Commonwealth o/MalsacLueetb Official Use Only I z Et Permit No. � S L a=,�l= 23 '-3 ' �] 'y �lJeParEmenE 0/Jire Serviced =_�_ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rev. 1/07 j (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 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1212242 City or Town of: YarrnotA-c 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) 50Tostran(aDrivt Owner or Tenant NICK Hays Telephone No. (y1-It9-$31- zii.f Owner's Address 50 1-ASW:01i°-D v e.. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 200 Amps / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead ❑ Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ,,vi66.c 0!< ,M14.Ni Q\i{g A.vvJl ho-k ujcekes \eo-Q,( Completion of the following table may be waived by the Inspector of Wires. ofTotal No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans To 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 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: 2. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters I Signs Ballasts No.of Devices or Eouivalent 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: It ip00 (When required by municipal policy.) Work to Start: 12'23 I22 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 cov rage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjuty,that the information on this application is true and complete. FIRM NAME: 1 .010ies Ikea c'9 £ Cooling LIC.NO.: Licensee: G�0.c\es V..• Su.)oar\SoC1 J1 Signature L. C.NO.. 12$q5 A (If applicable,enter "exempt"in the license number line.) Bus.Tel.1� : -11S-3O' 3 Address: 1 mc . Rol bic,,,mi 02lo01 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 PERMIT FEE:$ Signature Telephone No. ACCPR E1® DATE D/YYYY CERTIFICATE OF LIABILITY INSURANCE 11/15/ „/15/1(Y21 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 POUCIES 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 NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY NE HOME OFFICE:P.O.BOX 328 (A/C,MD,End:888-333-4949 I Im/c.Nol:507-446-4664 OWATONNA,MN 55060 IL ADDRESS:CLIENTCONTACTCENTERQFEOINS.COM INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 394-850-2 INSURER B: ROBIES REFRIGERATION INC INSURERC: 279 YARMOUTH RD HYANNIS,MA 02601-2038 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:57 REVISION NUMBER:0 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY err POLICY EXP OMITS LTR INSR WVDIMMIDDIYVYYI IMM/DDIYYYVI X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $1,000,000 CLAMS-MADE ❑X OCCUR DAMAGE TO ED PREMISES S.ocnSVrrence) $100,000 MED EXP(Any one P.nen) EXCLUDED A N N 6120004 12/21/2021 12/21/2022 PERSONAL SADV INJURY $1,030,030 OEN'L AGGREGATE OMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 RPOUCY [jECT ❑LOC PRODUCTS-COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY CO,Mill tlSINGLE UNIT $1000000 X ANY AUTO BODILY INJURY(Par penal CTOD A OWNED AUTOS ONLY ULED A _ _ CHED N N 6120003 12/21/2021 12/21/2022 BODILY INJURY(Par accident) NON-OWNED PROPERTY DAMAGE HIRED AUTOS ONLY ACTOR ONLY !Per ecddend X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $3,000,000 A EXCESS LIAR CLAMS-MADE N N 6120006 12/21/2021 12/21/2022 AGGREGATE $3,000,000 DED I !RETENTION WORKERS COMPENSATION X'PER STATUTE! I DER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y❑ EL EACH ACCIDENT $500,000 A OFFICER/MEMBER EXCLUDED? NIA N 6062307 12/21/2021 12/21/2022 EL DISEASE-EA EMPLOYEE (Mandatory In NH) $500,000 II yes.describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY OMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,AddiSorA Remarks Schedule,may be attached If more mace is required) GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. CERTIFICATE HOLDER CANCELLATION 394-850-2 57 0 TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 ROUTE 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH YARMOUTH,MA 02664-4463 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. 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