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HomeMy WebLinkAboutBLDE-23-003444 oR Commonwealth of Official Use Only Massachusetts Permit No. BLDE-23-003444 :IV 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) 41 UNCLE ROBERTS RD Owner or Tenant SCHEUCH RICHARD TRS Telephone No. Owner's Address YOUNG JOHN R TRS, 80 LOEFFLER RD G522/523, BLOOMFIELD, CT 06002 \. Is this permit in conjunction with a building permit? Yes 0 No 0 heck Appropriate Bo t Purpose of Building Utility Authorization o. 11463405 ,I S 1.l re - Utility Service Amps Volts Overhead 0 Undgrd No.of Meter New Service Amps Volts Overhead 0 Undgrd 0 No. ers Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 100A U/G service 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 D In- ❑ No.of Emergency Lighting grnd. grad. 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 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: 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: Licensee: Jon T Moreau Signature LIC.NO.: 22967 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:9 Redberry lane, MARSTONS MILLS Ma 02648 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 CammOmaaann o`tr/me6c411e46 Official Use Only --1 !r -'`"; c7� ��''// ��ii Permit No. �Z."3-- 3 4 cF 4 '..'st',7 2apartmeni a`.}ira Servicu9 af( 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 12/15/2022 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) 41 Uncle Roberts Rd Owner or Tenant Peter Fairbanks Telephone No. Owner's Address P 0 Rox 175 North Marshfield MA 2059 Is this permit in conjunction with a building permit? Yes 1.44 No ❑ (Check Appropriate Box) Purpose of Building Residential Utility Authorization No.11463405 Existing Service Amps / Volts Overhead El Undgrd❑ No.of Meters New Service 100 Amps 120/240 Volts Overhead El Undgrd 0No.of Meters 1 Number of Feeders and Ampaclty 3/1 0 Location and Nature of ProposedElecMcalWork: 100AMP UG Service lf Completion of the fsllowin•table m be waived by the/nspectar of Wires. l :1) No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total Ci Transformers KVA C1 No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above in- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grin; ❑ Battery Units No.of Receptacle Outlets No.of OB Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and F Initiating Devices Tota IL) No.of Ranges No.of Air Cond. Too 1 No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/AlertingDevices Mipal No.of Dishwashers Space/Area Heating KW Local❑Connection ❑other No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Whing Y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 500.00 (When required by municipal policy.) Work to Start: 12/30/2022 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 ix BOND 0 OTHER❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Coastal Mechanical LIC.No.:22g67-A Licensee: Jon T Moreau Signature rL7IiP'.eccU LIC.NO.: 8082 Al (If-applicable,enter"exempt"in the license number line.) Bus.Tel.No.• 502._737-8747 Address: 21 L Fruean Ave S.Yarmouth MA 0266 AIL TeLNo.:5f1R-326-9699 "Per M.G.C.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:$ 50.00 Signature Telephone No. DATE(MMIUll/Y YY Y) ACC*D CERTSCATE OF LIIAB UTY lNSU A C E 12115/2021 �._ THIS CERTIFICATE IS ISSUED AS A MATTER or: INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFrCATE 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 he 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). CONTACT Tina Reeves PRODUCER NAME:Dowling &O'Neil Insurance Agency PHONEFAX{AO,No, (800)640-1620 Ext): I tA/C,No): E-MAIL treeves@doins.com 973 lyannough Road • ADDRESS: , • INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 Hartford Underwriters Ins Co 30104 INSURERA • INSURER B: Safety Indemnity Insurance Company 33618 INSURED 37478 Coastal Plumbing &Heating LLC : INSURER C; Hartford ins Company of the Midwest 211 Fruean Way INSURER D: • INSURER E: MA• 02664-1690 f INSURER F: `�°� . South Yarmouth -= - ;�. cL211214g3489 REVISION NUMBER; COVERAGES CERTIFICATE NUMBER: .�� THIS IS TO CERTIFY T I-1AT TrtE POLICIES OF INSURANCE LISTED SELD1NIt�lf ©F ANY CGPITRA HAVE BEEN ISSUED�©;`:OTHER DOCU THE INSURED MENT WED ITH R VE Q PECT R THE�iJ�1OLtV 8CY C1-!PER�D INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CON HIS 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. AIL sum POLICY EFF POLICY EXP LIMITS- .' TYPE OF INSURANCE INSD bW0 POLICY NUMBER -:JMM!DD/YYYY) : (MMIDDIYYYY) I LTR 1,000,000 <; COMMERCIAL GENERAL LIABILITY I j EACH OCCURRENCE $ ,,,; DAMAGE TO RENTED 1,000,000 ) CLAlIJS-MADE �� PREMISES{Ea accurren� $ l OCCUR i'iED EXP(Any one person) 1 $ 1a,000 A 08SBAA7RXH 1213112021 12131/2022 0000 P=RSOdAL&A3ViJJURY $GENERALAGGREGATE 2,000,000 GE�I�I_ACGRaGATEL11,�Ir APPLIES PI=R:✓ti 2,000,000 ^^�� i PRODUCTS-COMP/OP AGG POLICY i PRO I 1 LOC 3 $ OTHER: ► COh�i81t�1=D Sll<GLE LIiiT $ 1,000,000 AUTOMOBILE LIABILITY (Ea accident) • ANY AUTO BODILY INJURY(Per person) S ' B OWNED v SCHEDULED ' 5915690 12/31/2021 12/31/2022 I BODILY INJURY{Per accident) AUTOS ONLY �, AUTOS PROPERTY DAMAGE $ ti✓ HIRED 's../ NON-OWNED PROPERTY accident) ,� AUTOS ONLY �'" AUTOS ONLY $ ' UMBRELLA LIAS I OCCUR ' EACH OCCURRENCE $ I EXCESS LiAB CLAIMS-MADE AGGREGATE $ • • I $ DED I I RETENTION $ 3 - +�.,+'� PER � � OTH- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY Y 111 E.L.EACH ACCIDENT 11 $ 1,{300,000 C ANYPROPRIETOR/PARTNER/EXECUTIVE t�° O8'IVECA J RTC 12131/2021 12/31/2022 1 000 0fl0 (Mandatory date y in NH) ExGLUDED? E.L.DISEASE EA EMPLOYEE $ ' {I�iandat�ry in NH) 1 000,000 If yes,describe under • E.L DISEASE-POLICY LIMIT $ ' DESCRIPTION OF OPERATIONS below • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORI3 f el,Addition s1 Remarks Schedule,allay be attached if more space is required) Insurance coverage is limited to the terms, conditions,exclusions, other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered, waived, or extended thecoverage provided by the policy provisions. A CERTIFICATE HOLDER � �. . • 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. Town Hall; 1146 Route 134 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 --'r- ,---. • ©1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD