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Home My WebLink AboutBLDE-23-005120 Commonwealth of Official Use Only 1 E ' Massachusetts Permit No. BLDE-23-005120 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:3/17/2023 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. Location(Street&Number) 123 WIANNO RD Owner or Tenant RICHARD VENTTONE Telephone No. Owner's Address 123 WIANNO RD, 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 0 Q o.of Meters New Service Amps Volts Overhead 0 Undgrd MettL 9 7 Number of Feeders and Ampacity Q Location and Nature of Proposed Electrical Work: Miscellaneous work per attached. ' 1 �`' / V J r_� Completion of the following tabiV /bg s b ,fin ctor of Wires. No.of . ; ;,�r'�, "✓ /` Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers y'` f f /, N. KVA No.of Luminaire Outlets No.of Hot Tubs Generators . -/�`; KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lightir 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 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 ❑ Municipal ❑ 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: 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: DANIEL E DICESARE Licensee: Daniel E Dicesare Signature LIC.NO.: 21275 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:66 ELK RUN, MIDDLEBORO MA 023463065 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 644— Telephone No. PERMIT FEE: $75.00 CZ� -%t-r) 7/?34 ({04 —`6 (53(f(u)(Cilt &) �9 �gf� JJ tt' I official Use Only �\ Lorrasxt ouvi zits, ,44,0 ,449Stts O3 -S ��V �, a cc77 Perm.tNo. ti 'IVipartn,a,t o burliruics� Occupancy and Fee Checked ' BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave bleak) rj APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Maya:hosetts Electrical Code(MEC).527 CMR 12.00 el! (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 3/1.3 /a.3 '1� City or Town of: Ya r rra o.)-�+ To the Inspector of Wires: WBy this application the undersigned gives notice of his or her intention to perform the electrical work described below. J Location(Street&Number) j a 3 (.J;a n r O R n l'il Owner or Tenant Telephone No. _ Rr chcxrs� 1f�,"-r-rouse. �_ wner �..tteress 4 � '� 1.v` Yes L`LI u a (Check Appropriate Box) Is this permit in conjunction with*building permit? Purpose of Building S ,.+q IL ra r✓a:C Y Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps 1 Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Anspitelty Location and Nature of Ptupeied Electrical Work: Re,.•,bve,, are z.Plac., 13``a'0,reo, AI, 14:3 1+T et„b Rem a�t Qr•c� 1a3,,. 3 X T-Ctnv, L;��o-I krS a net .n:To l I. e Re. 4 CC .Al r 3 Car.c1 a i,+cl W�'fh t'k k1 � table may be waived by the! r of Wires. ,,, Completion of the ftttlbwing Dial r �No.of � 'No.of Recessed Luminaires No.ofCeib.-Susp.(Paddle)Fans Traaaformers K'A VA No.of Luminaire Outlets No.of Hot Tubs Generators Above in- No.of Emergency Lighting No.of Laminates Swimming Pool mod, ❑ rod, Li Batterzyuits No.of Oil Burners FIRE ALARMS 1No.of Zones No.of Receptacle Outlets No.ofI}eteetion and No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices IV No.of Ranges No.of Air Cond. Tons -Heat Pump Number Tons KW ;No.of Sdf-ContaIued No.of Waste Disposers Totals: Detection/Ale Dermas ('''[Municipal � No.of D Space/Area Heating KW �CI Connection D No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent Zyo.of Re.of Data'Whim: No eFW Heaters I{W Signs Bass" No.of Devices or Lq:ursIent Telecommunications irin : Total HP No.Hydromassage Bathtubs No.of Motors No.of Devices or Equivalent OTHER: Attach additional detail ifelesired or as required by the Inspector of Wires. Estimated Value of 1 Work: (When required by municipal policy.) to be requested in accordance with MEC Rule 1tt,and upon completion. Work to stare:. 3�/y Inspectionsissue unless INSURANCE COVERAGE Unless waived by the owner,no permit for the performance of electrical work may the undersigned licensee provides of of liability insurance including"completed operation"coverage or its substantial equivalent. The .. undersigned certifies that such collage is in force,.and has exhibited proof of same to the permit issuing office. ONE: INSURANCE BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties ofpet)ary,that the information on this application is true and complete. FIRM NAME: D c.,c} C L e eT r:G L.L C >r.rC.No.: a 1 ar)S A Signature e08 LIC.NO.: Si 6.5a£ Licensee: 1�ca;;,z!~ r= D i Ce.s�sz S fore sus.Tel.No.: ?�7 i MI5$ 9170 (If applicable enter"exempt"in the licence number tine.) Address: E ELK R�r t- CA;(VS Liebcsr� NIA c3c93I6 Alt.Tel.No._"as hS ? $185 *Per M.G.L.c. 147,s.57-6I,security work requires Department of Public Safety"S"License: Lie.No. ,`1 SC o 0 O 13 7 3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurancecovera normally required fired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 0 ,, eCi 1 PERMIT FEE:$ S�- 1 Owner/Agent Telephone No. Signature ALL Done ot. word , Ora 1 ne..ce 1 imspecT►a,--) The F Commonwealth of'��Yassczc fz�csefts 4 • --- Department of industrial Accidents 1 4 Congress Street, Suite .11.0 4yMA 0''1i 4_'2017 p� ]3ostorz, r. V4 /ray; www.mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name �(Business/Organization/Individual : L L C ) an y\ �l += Le c-•�r, c. Address: 6 E F L.K W u;-. 0 R City/State/Zip ;c:„ , F 4, �,� ?L �Ya 1 Phone : y 9 Arc you an employer?Check the a __.__ ppropnate box: — t.R�'r am a employer vith Type of project(required): ._employees(full and/or part-time).* _ f� '- n I am a soleproprietor or �• 0 New construction partnership and have no employees working for me in any capacity.[Na workers'comp.insurance required.] 8. Remodeling 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]f 9. 1 Demolition 4.[j I am a homeowner and will be hiring contractors to conduct ail work on my property. I will ensure that all contractors either have workers'compensationI0 ❑ Building addition proprietors with no employees. insurance or are sole 11.[] Electrical repairs or additions 5.EIamage and I have hired the sub contractors listed on the attached sheet 1 2•El Plumbing repairs or additions general contractor These alb-contractors have employees and have workers'comp .insurance. 13.El Roof repairs '`�. We are a corporaton and iu officers have exercised �2, I i i theirright of exemption per MGT_,c. E ?`� Other !$ ) and wr,have no m loys -- I_ __ F n.[No worker;'comp.insurance required!.] �7y appi leant tea:check;box- 1 must also fill out the section below showing their workers'compensation; f Homeowners who submit this 41 sit indicatingtheyr, �� are doingallre outside p' !policy ibfbra arrow ;Contractors that check tilts box must attached an additional shee howling the name of the sub-contractors and state whether or not those e affidavit ntities s have employee,. the have employees,th If e sub-con�iaors h - the _ ey 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: I ra. v e ' 5-- Policy 4 or Self-ins.Lie.#: U R ) -j cj I 'v I Expiration Date: (� l g 1 a 3 Job Site Address; A.ttacii a copy of the workers' compensation policy declaration page(showinthetpolicy nu er and ea ira ' Failure to secure coverage as required under MGL c. 152 0� l p iron date). by a fine up to S1,5 and/or one-year imprisonment,as well as civil penalties in the for�n of a STOP WORK ORDER and a fine of up to S250.00 0.00 day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance a coverage verification. _ I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. >L. _icnature: of__ .4_41 ,• ,, Date- .3.0 2.1 E �_._._...__._._.._ - •-_._._.....__._...._..—........__----._-_...__ I Official only. ..- not write in--„thi area, to completed. ..T == =�-"..� `.."...� ._.__� li r i, be by city or town official — --____ ICity or Town:_ - ---. Permit/License# Issuing Authority(circle one): ��- - I 1 I.Board of Health 2. Building Department 3.City/Town 6. Other r Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: _ Phone#: