The URL can be used to link to this page

Home My WebLink AboutBLDE-24-596 4/11/24,6:50AM about:blank — Commonwealth of Massachusetts of .. , yr*u Town of Yarmouth ;,,,„ �`� ELECTRICAL PERMIT Job Address: 24 EASY ST Unit: Owner Name: SAND DOLLAR PROPERTIES LLC Owner's Address: 259 GREAT WESTERN RD UNIT B Phone: Email: Purpose of Building Commercial Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-596 Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters: New Service Amps/Volts Overhead❑ Underground 0 No. of Meters: Description of Proposed Electrical Installation: Install 4 double duplex receptacles in newly framed wall. No.of Receptacle Outlets: 8 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: In-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 0 Ground-Mount❑ Level 1 ❑ Level 2❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 800 Work to Start: April 11, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: DANIEL E DICESARE License Number: 21275 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: MIDDLEBORO, MA, 023463065 MIDDLEBORO MA 023463065 Fee Paid: $100.00 Email: dandd.electric@verizon.net Business Telephone: 508-697-8185 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: ad 104( > C;--KM-c-- 41 2IL6J1 r---- --- about:blank 1/1 /D0.aa • Commonwealth 7 a c Official Use Only y al. , spar i.&� Permit No. - 2 iL ) c C I Occupancy and Fee Checked ..., ;• BOARD OF FIRE PREVENTION REGULATIONS Rev. 1i0 71 (leave blank r ' APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK MI 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: y//0/0? Y City or Town of: 10.rn,o uT4, To the Inspector of lei L By this application the undersigned gives notice of his or her intention to perform the electrical wor r a� .' E J Lees en(Street&Number) a 4.4 S`f 5 - Om;-r #i= IA H Owner or Tenant ,J a el r5 6o Li..cur Co.5 f o.rv.s Tele NAP!? 10 2024 Q Owner's Address S5 Cr Cc.a't" t,.Te5 fin? RD Yo.rwlov`t.a l 0 No ❑ (Cheek'AP c nogPArlTMENT Is this permit h conjunction with a trait? Yes Purpose of Building Co nTrti c 1-a e• imp,/ Utility Authorization No. Existing Service Amps I Volts Overhead❑ Uadgrd Q Na of Meters New Service Amps / Volts Overhead 0 Undgrd Q No.of Meters • Number of Feeders and*opacity Location and Nature:of Proposed Electrical Work: �r\STa Y De� (,e r}vf le..- �S cerrc<LL.0 .�( VI Completion 1 tke�oilawirtktahle may be waived by the hslectar of Wires, r 41 No.of Recessed Lvgminsires No.of Celt,-Susp.(Paddle)Fans Tr ofTotai Transformers KVA LZNo.of Luminaire Outlets No.of Hot Tubs Generators KVA • Na.of Luminaires Swimmin psi Above In- No.of 5mergency Lighting grnd. C7 a d. O Battery units • No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones • Ne. o.of Switches No,of Gas Burners No.of Detection and Initiating Devices To t I-i No of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste I iposers 'Beat Pump Number Tons_ "KW `No.of Self-Contained Totals: ^�" Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKWMunicipal p Local 0 Cyyassttnneetion 0 Other No.of Dryers Heating Appliances KW 4f Devices or E uivalent No.of Water , No.of No.of Data W q heaters Signs Ballasts No.of Devices or Equivalent No.Ryd e Bathtubs No.of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER: cal Work: O 0 Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Blectri Y/r1 /aY Inspections (When��municipal��•) Work to Start to be requested in accordance**MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance the licensee provides proof of liability insurance including"completedof substantialelectcal work equivalent may issueunless undersigned certifies that such a is in operation"coveragetheer its suing The force,and has exhibited proof of same to the permit issuing office CHECK ONE: INSURANCE al BOND 0 OTHER 0 (Specify:) I mei&under the pains and penalties of perjury,that the titfor on on this application is true and complete. FIRM NAME: D ar a D F'Le.cTr.c LLC LIC.NO: i cc"Sc Te. Signature 08cm-a<o}, ,,,, LIC.NO.: S16.¶s1E (If icvblA elm",srempt"in the license nwnber line.) 1$/ 85 Address: (E' ELK Run [>c /"►ic�ic�te6orc ftlA cla3y6 Bus.Tel.No.• 8 '1I70 "Per M.G.L.c. 147,s.57-61,security work requiresetyAlt.TeL Na.: 5o$ E,9'1 $ gs OWNER'S INSURANCE WAIVER: I am aware thatc Departmentseef �no the habit' Lie.icense: n c S C t'�- y O 13?3 required by law. By my signature below,I hereby waive thisone insurance coverage normally requirementOwneragent I am the(cheek one owner owner's nt. Signature Telephone No. PERMIT FEE:$ _ The Commonwealth of Massachusetts 1"' Department oflndustrialAccidents I Congress Street,Suite 100 +�c Boston,MA 02114-2017 ar 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/ndividual): F)a.,\ 1 f 1 e c---;C L L C Address: 6 6 F I K Run OR City/State/Zip: c}c}Le 41aco MA O 3Y6 Phone#: ,5 v S 6 97 81$ Are you an employer?Check the appropriate box: Type of project(required): I.2/1 am a employer with 3 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 I. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]: 9. ❑Demolition • 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property.I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employee. 12.0 Plumbing repairs or additions 5.❑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.: 13.❑Roof repairs E. We are a corporation and its officers have exercised their right14.0 Other ❑ orpo of exemption per MGL c. 152,11(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. ttConttactors that check this box must attached an additional sheet showing the name of the sub-corm airs 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. Insurance Company Name: I>—a v e_L e s 5 Policy#or Self-ins.Lic.#: — I T 9 Fi l R O l- 19 -y a Expiration Date: (,L9 1 AtH 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 coverage verification. a I do hereby cerQtify rtunder the pains and penalties of perjury that the information provided above is true and correct. Signature: 0 I ru/r/',:/ ;(cu. Date: Phone#: (5 R 6 77 R I g 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 6.Other Phone#: Contact Person: