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Home My WebLink AboutBLDE-23-002873 . _ l` Commonwealth of official use only ( Massachusetts Permit No. BLDE-23-002873 "" K 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:11/23/2022 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) 24 EASY ST Owner or Tenant SAND DOLLAR Telephone No. Owner's Address 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: Installation of fire alarm system. 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 1 No.of Switches No.of Gas Burners No.of Detection and 34 Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices 18 Tons Heat Pump Number Tons _ KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 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:) 1 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.: 21275 (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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $115.00 64 11 ( o(7 - (irc ' iv/C.Z) RECEIVED Cammanu aa[pt.,rn5^re 410V 2 3 2122 Official Use Only t 23-Z P t 67 3 ' 2sparliwni of Jirr�e !� su1L DING DEA-•I -1,,,, yandFeeChecked BOARD OF FIRE PREVENTION :a • - a• _ .- . I 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 l a3— City or Town of: �QTI i 10 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) a1-i U Owner or Tenant 5(,Q,1'1 L( Dolt CAf Eu,si-o YYL S Telephone No. Owner's Address Acct. CI(za (AJeS kr(! act Un.t+ �Q. 5' anal cs MO- Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) lv Purpose of Building I raeLiiffl, `Lly1 dur[?JLL> 5 Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters 46, New Service Amps / Volts Overhead LiUndgrd❑ No.of Meters 04 Number of Feeders and Ampacity (� '' // /' Location and Nature of Proposed Electrical Work: /�S - I,eA)on G G c •n Iartnes ,f'4 'I ,/1 .. et ),0�� s9.4.Sflxaqrr bld�r J .v Completion of the followingmble may be waived by the!n pector of Wires. lb No.of Recessed Luminaires No.of Celi.Sus.(Paddle)Fans Tr Trsno.of KVAohl �` P formers Gt No.of Luminai a Outlets No.of Hot Tubs Generators KVA Above in- No.of Emergency Lighting No.of Luminaires Swimming Pool grid ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones 1 Z 'No.of Detection and F No.of Switches No.of Gas Burners Initiating Devices..)y!ni• A 't7t) IL) No.of Ranges No.of Air Cond. Tons Total No.of Alerting Devices ip J is rs Heat Pump Number Tons KW 'No.of Self-Contained No.of Waste D Pox Totals: .... . ......._.......... ..........._. ..... Detectioo/Alerti Devices ...... Municipal Ceyt.}rp,l No.of Dishwashers Space/Area Heating KW Local❑Connection 0,5r E.4i d't ftlosli�WJc No.of Dryers Heating Appliances KNy Security Systems:" ry No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent dromassa a Bathtubs No.of Motors Total HP 'rd Nommue Devices ors Wiring: No.A Y g No.of Devices Equivalent OTHER: * _ Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: i�:0-TrO (When required by municipal policy) Work to Start: 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 op BOND❑ OTHER ❑ (Specify:) /certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: D-`T) t1Q.C.k'•nc. L-L_L LIC.NO.:2I2-?5A Licensee: Dani 0 E,T>i(1sa,re Signature,ID axt.a,t,Q„ l 2-, LIC.NO.:.YIlp,5-L E (If applicable,enter"exempt"in the license number line) Bus.Tel.No..72!-V56'-9t Address: (0(0 Ele-tLUrI Dr, Middleboro I''l\ OL31-!La Alt.Tel.No.:SD11-6q -545 °Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. SSC 0-CO 137-3 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. 1 am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. The Commonwealth of Massachusetts 1W— Department of Industrial Accidents �= 1 Congress Street, Suite 100 �' = Boston, MA 02114-2017 ,,;,�Y•�'' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TUE PERMITTING AUTHORITY. Aoolicant Information Please Print Legibly 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. ❑New construction 2. 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.[II am a homeowner doingall work myself.[Not 9. ❑ Demolition ❑ y workers'comp.insurance required.] 4.❑I am a homeowner and will be hiring contractors to conduct all work on mYproperty. I will 10 ❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box 41 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. 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: