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Home My WebLink AboutBLDE-23-004768 Commonwealth of Official Use Only ATM Massachusetts Permit No. BLDE-23-004768 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:2/28/2023 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) 29 JOHN HALLS CARTPATH V Owner or Tenant BARBO S DOUGLAS Telephone No. Owner's Address BARBO LINDA D,92 COLONIAL DR, READING, MA 01867 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 ❑ 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: Remove ceiling light and install(2)6"lights to accommodate new skylight (781-858-9170) 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 ❑ In- ❑ No.of Emergency Lighting 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 Initiatine Devices 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/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: 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:) 7€1 -e Sg -6/r7o 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.: 51652 (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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 RECEIVED Co... 490 fia 2 8 2023 Official Use Only f r� c-� . Into. 13 LOE'- z 3 --eV`/ �y -' � 2epartmwsi of • �Q1AIf DEPARTM NT C * :` S 8Y -- ancy and Fee Checked r- µma . BOARD OF FIRE PREVENTI ev. ilfl7) {ieaveblan f Ni APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Mag APItusetts Electrical Code(MEC).527 CMR 12.00 1,1 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a /,') 1 a 3 • City or Town of: Ye.r M 0.,-rk, To the Inspector of Wires: JBy this application the undersigned yes notice of his or her intention to perform the electrical work described below. Location(Street&Number) a 9 Sohn 14A LL Carr LiJc`1 Fi Owner or Tenant 1.,;.v c. 13a;bC Telephone No. Owner's Address ,.�a.vwe 1y Is this permit in conjunction with a building permit? Yes No C (Check Appropriate Box) Purpose of Building Si q Lc- tea.-.o c'1 Utility Authorization No. Q. Existing Service Amps 1 Volts Overhead E Undgrd❑ No.of Meters "CINew Service Amps 1 Volts Overhead E Undgrd E No.of Meters Number of Feeders and Ampacity 1 Location and Nature of Proposed Electrical Work: Ce. L. t, L + TA-) a t,L k* (C .) 6'' W A.1-o- c;rt 0 -5 i c., a_ cc o,,,,c e)4T'c t\ ...J , / L,V.- �, Completion of the following_table may be wW4ed by the Insyector of Wires, 4.41 No.of Total t(. No.of Recessed Luminaires No.of Ce 1.-Susp.(Paddle)Fans Transformers KVA � No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool 1 � ❑ pad, ❑ Battery Units ^-, No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS tNo.of Zones ''No.of Detection and No.of Switches No.of Gas Burners Initiating Devices 11-' No.of Ranges No.of Air Cond. Toys No.of Alerting Devices Heat Pump 1 Number Tons...._. Imo' 'No.of Self-Contained No.of Waste Disposers Totals:i J Detection/Alertia&Devices Space/Area Heating KW l❑ cipal No.of Dishwashers P Loca Connection ❑ HeatingAppliancesSecurity Systems:* No.of Dryers KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent O t'HER: 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: a)g7 I,,3 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the pciformance 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 cov ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND 0 OTHER 0 (Specify:) I certift,under the pains and penalties of perjury,that the information on this application,is true and complete. FIRM NAME: L� a c L e. ;L L L C LIC.NO.: 1 o� 6 A Licensee: --)c;i, z L E: 17 i Cc Sc7.-z Signature c,n,,.k'e 0a7,ear,a LIC.NO.: Si 6 9,E. (If-applicable,enter"exP.mpt"in the license number line) Bus.Tel.No.: 7 i 4 i i 7G Address: 6 E ELK R,,1 i"l c PA-I C i- - b c,r c- PIA C!9 3 6 Alt.Tel.No.: So a to 17 51 SS *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. ,S S C C` -' 0 G, i 3 7 3 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)G(owner 0 owner's agent, Owner/Agent Telephone No. PERMIT FEE: 7 Signature The Commonwealth of Massachusetts T Department of Industrial Accidents 5. a 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.asass.gov/dia Wcrkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Pnat Lemhry Name(BusinesslOrganizanon/lndrvtdua!)•�p Address: 6 t_)n 0 R • City/State/Zip: 111 c}11 e rg n^zv Phone#; ,jUg 69� Rl SS Are you an employer?Check the appropriate box: 1.21 am a employer with 3 employeesType of project(required): (full and/or part-tune).* 2.0 I am a sole proprietor or partnership and have no7. ❑New construction capacity.any P employees working forme in [No workers'comp.insurance required.] 8. Remodeling 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]r 9. ❑Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property.I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.0 Electrical repairs or additions 5.0 1 sm a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.0 Plumbing repairs or additions These sub-contractors have employees and have workers'comp.Insurance.t 13. Roof repairs 6.0 We are a corporator and its officers have exercised them I4. Other per 52,11(4),and we have no employees.[No workers'camp insurance equired)MCd,c. .Any applicant that checks box#1 must also fill out the section below showing their workers'co 'on 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 :Contractors that check this box must attached an additional sheet showing the name of the sub-co employees,If the sub-contractors have employees, nnumber and state whether or not those entitieshave such. p ogees,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: TI-o,a e e r Policy#or Self-ins.I.ic.#: Ulf- 1 T 9 p i A ya O I 14 Expiration Date:_ JobSite Address: dt Attach a copy of the workers'compensation policy declaration page City/State/Zip: e 7 g the policy nuber and expiration date Failure to secure coverage as required under MGL c.152,§25A is a criminal wviol on pun shableby 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. 7 rin ho...r...,.__.:c.__ y tto under the pains and penalizes of perJury that the information provided above is true and correct. Si nature: c2^ �1Z 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#: