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HomeMy WebLinkAboutBLDE-23-003523 Commonwealth of Official Use Only L: , Massachusetts Tht::§ Permit No. BLDE-23-003523 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:12/28/2022 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) 15 WEST RD Owner or Tenant DEVER EDWARD J JR Telephone No. Owner's Address DEVER PATRICIA M, 15 WEST RD,WEST YARMOUTH, MA 02673 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 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Bedroom/bathroom remodel,wire 2 heat pumps and add sub-panel. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires 18 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 ❑ In- ❑ No.of Emergency Lighting grad. grad. Battery Units No.of Receptacle Outlets 20 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 10 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 ❑ 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: 12/27/2022 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: Licensee: Simon Baba Signature LIC.NO.: 22714 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:29 Captain Lumbert Lane, Centerville Ma 02632 Alt.Tel.No.: 7749949255 *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 j Telephone No. PERMIT FEE: $75.00 1``evXrii- t'J kt s )C67cAl6S ()le_ 12J3rj/z i sv Sr 0 +dr i5tcm' Ourstba, 1RECEIVED1 our [ty of tr/aeeachimatte Official Use Only DEC c-� �i Permit No. E7,3SS23 �:�.� aaYrtrrra^t�Jin Serviced I�,, i_ r _ Occupancy and Fee Checked i ReV�NTION REGULATIONS (Rev,l/07j (have 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: I Z 27 22 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) I:Jt L�PYI-t'Q 95 act "I Owner or Tenant �G C K i a,SeVI Telephone No. Owner's Address Is this permit In conjunction with a buildingpermit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampadty Location and Nature of Proposed Electrical Work: 3 bece(Ccl,.l stick✓Cal rl feee_,/ie 1. ,1 p� k- t p ill,p5 GE� cz.a , _)1-) I ik bv '.w setv-. W nCompletion rf the folowingtable may be waived by the Insppector of Wires. i) No.of Recessed Luminaires 16 No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA n No.of Luminaire Outlets No.of Hot Tubs Generators KVA st No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grad. grad. Battery Units ' No.of Receptacle Outlets ZO No.of Oil Burners FIRE ALARMS No.of Zones U -No.of Detection and • No.of Switches / No.of Gas Burners Initiating Devices Ill No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Disposers / Heat Pump Number Tons KW No.of Self-Contained Totals: - Detection/AlertinglDevices No.of Dishwashers / Space/Area Heating KW Local D Munieitlon 0 Other No.of Dryers / Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts 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: I b.006 (When required by municipal policy.) Work to Start: I Z. 'Z6-2Z 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 coveppe is in force,and has exhibited proof of sarne to the permit issuing office. CHECK ONE: INSURANCE( BOND ❑ OTHER❑ (Specify:) I certify,under the sins and penalties of perjury,that the infarmatlan on this application is true and complete. M FIRM NAE: "J;rvson"72)4bh b LIC.NO.: 22.7/41Q C Licensee: Ji^rNh i r1121 Signature �-.y,,,_'�//� LIC.NO.: 530253 (If applicable er�l{er"exempt"in the license number hire.) Bus.Tel.No.•77K(NY 02SS Address: _4 c'aou \,, (.tn+^bo(f} hire.)t,e- 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. To: Page: 2 of 2 2022-12-27 15:09:11 EST 18663713215 From: Cheryl Woodsic --- SIMOBAB-01 CWOODSIDE A41CC7►RL CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDYYYY) 12/27/2022 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 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 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 License # 1780862 € CONTACT I NAME: Anne Sanzo HUB International New England I PHONE 945-78fi3 FAX 265 Orleans Road (A/C, No,Ext): {SQ$} (A/C, No): E-MAIL anne sanzo@hubintemationaicom North Chatham, MA 02650 _Apnr�Ess;.-------.._._..� • INSURER(S)AFFORDING AFFORDING COVERAGE NAIC # INSURER A:Selective of the Southeast 39926 INSURED INSURER B :Arbelta Protection Insurance Company 41360 Simon Baba INSURER C: The Neighboorhood Electrician LLC 29 Captain Lumbert Lane I INSURER D Centerville, MA 02632 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITSLTR INSI� WVD (MM,DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLA11,,1S-t:<.AD E X OCCUR S 2229038 7111/2022 7/11/2023 DAMAGE AMA ETO a oc uEr°nce).._. 5 - 500,000 15000 IvIED EXP iAny one person)_ S , PERSONAL & ADV INJURY S I,000,000 3 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S ' ' 000 Oft} - LOG PRODUCTS-COMP/OP AGG 5 3,000,000 ; JECT OTHER: _ S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,0€0,000 (Ea accident) ..............._......._ ..........._ ............ ._......._. ANY AUTO 1020095244 3/6/2022 3/6/2023 BODILY INJURY Per person) S 20,000 OWNED y AUTOS ONLY X AUTOSUI..ED BODILY INJURY (Per accident) S �O,fl04 HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY .—. AUTOS ONLY (der accident) S. S UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S — DE3 I RETENTION$ S WORKERS COMPENSATION PER ` OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE....__..............__ER ANY PROPI:IE1`OR.:PARTAIER/EXECUTIVE i 1 EL. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? i j N f A __ ......._.. .................... (Mandatory In NH) �_........__ E.1_. DISEASE -FA EMPI...OYI=E S if yes,describe under — .................._........ . DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT S E DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is listed as Additional Insured for General Liability when required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE (1.---2--2.,-. /4,, -.4 Z. ) ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. Al! rights reserved. The ACORD name and logo are registered marks of ACORD L7 OW-Shpt.- l)odt g0,lrsrnr 12Owr