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Home My WebLink AboutBLDE-23-19045 . :, ,s' i oc ;/2.i, 1:47 PM about:blank A,. Commonwealth of Massachusetts o� YA47* *4‘ Town of Yarmouth „ y ELECTRICAL PERMIT Job Address: 500 ROUTE 6A Unit: Owner Name: FITZGERALD SHEILA M TRS SMF REALTY TRUST Owner's Address: PO BOX 535 Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-23-19045 Existing Service Amps/Volts Overhead 0 Underground 0 No.of Meters: New Service Amps 200/Volts Overhead 0 Underground M No. of Meters: Description of Proposed Electrical Installation: New residence No.of Receptacle Outlets: 100 No.of Switches: 30 Generator KW Rating: Type: No.Luminaires: 10 No.of Recessed Luminaires: 40 No.Wind Generators: Wind KW Rating: No.Appliances: 4 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 0 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 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 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 0 Level 1 0 Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $ 65,000 Work to Start: July 3, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: JARLATH A GALVIN License Number: 10861 Security System Business requires a Division of Occupational Licensure "S" LIC. Licens urn er: Address: Yarmouth Port, MA, 026752045 Yarmouth Port MA 026752045 Fee P id: $180.00 Email:jargalvin@comcast.net Busin s Tele . 508-488-7487 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 th permit issuing office. INSURANCE: 1 3 7 6270 14 izEkx4 cli-zslvl 0 .. e iti I2( 3 C(2.3l'i, Kr-- 1-11 e-6(c 3 (up ( _ ((14-A-c- -5 I 47_c_( r ---- r( about:blank 1/1 C � M ommonwaa o`lr/aeaac Official Use Only(� ti •_= cyy� c� ��ii Permit No. .22 — �(O 11. `heparGsuni el..tin Jarviced I- Occupancy and Fee Checked 4 -' 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(ME 527 CMR 12.00 (PLEASE PRINT IN INK OR T PE ALL INFORMATION) Date: s,i' 4�� City or Town of ��LHk..-+ Ti'rho�ts�ector of Wires: By this application the undersign gives notic of hi.s{{oor-r her intention to perform the ele ciwork described below. - Location(Street& umber) SGO c44_ 6 CtRsa Z OR aOwner or Tenant f' ci AU t s y��{ya Telephone No.3.Lt g ttf 1:93- Owner's Address st 1 0 U Is this permit in conjunction with a building permit? Yes l No ❑ (Check Appropriate Box) 3 Purpose of Building '1-..p1ge_ Utility Authorization No. Existing Service LOD Amps S I Volts Overhead❑ Undgrd❑ No.of Meters P oNew Service 2.0t Amps 2.140/ Ito Volts Overhead❑ Undgrd gel No.of Meters Number of Feeders and Ampacity ` Location and Nature of Proposed Electrical Work: W IIK- t,Y }o Completion of the following table may be waived by the Ingector of Wires. Transformers KVA No.of Recessed Luminaires 40 No.of Cell.-SusP.(Paddle)Fans No.of No.of Luminaire Outlets ^ No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of emergency Lighting 110 grnd. grnd. Battery Units No.of Receptacle Outlets (00 No.of OH Burners FIRE ALARMS No.of Zones and No.of Switches No.of Gas Burners No.of Detection Devices Initiating Devices No.of Ranges -. No.of Air Cond. TotaTons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Pos Totals: Detection/Alerting Devices Mu No.of Dishwashers 1, Space/Area Heating KW Local❑'au::nectio pain ❑Other No.of Dryers 2 Heating Appliances KW Securis:* No. f Syyo Devices or Equivalent Z No.of Water KW No.of No.of Data Wiring: u.. Heaters Signs Ballasts No.of Devices or Equivalent LI cars-s No.H dromasaa a Bathtubs No.of Motors Total HP Telecommunications Wiring - y g No.of Devices or Equivalent �yw� co J OTHER: u is O VI Attach additional detail if desired,or as required by the Inspector of Wires. ..) J-, �z stimated Value of EI trilcal Work:, 6,1t(300 (When required by municipal policy.) L' ork to Start � ,3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. t ,i SURAN RAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless e 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 pedury,that the information on this appl' lion is true and complete. FIRMNAME:SAO.-Atl.t &AtJsN , t LIC.NO.: ►()C6l% Licensee:�AQlsit►{ 6-sumo Signature / ,i,G��, l LIC.NO.: (O8L l 2i Of applicable,enter''` �"+(em�t rn t�yjey tense n mbar lirt�,.�}- Bus.Tel.No.' t{B$ 1148 Address: Ktxt1t 6/l agMt)4,llw, 1414' Alt.Tel.No.: 'Per M.G.L.c.147,s.57-61,security w rk requires Department of Pub is Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: 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 0 owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. • The Commonwealth of Massachusetts -- Department of Industrial Accidents =t. = 1 Congress Street, Suite 100 : �= Boston, MA 02114-2017 ,,F www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeQiibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): i.❑I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑ Demolition ❑ y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on mYp roPrtY• e I wil{ 10 n Building addition •ensure that all contractors either have workers'compensation insurance or are sole 11.[] Electrical repairs or additions proprietors with no employees. 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.= 1 •❑Roof repairs 6.0 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. 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 job site information. Insurance Company Name: Policy# or Self-ins. Lic.#: 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 coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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 Contact Person: Phone#: