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Home My WebLink AboutBLDE-23-15870 Commonwealth of Massachusetts =o-v YA 4* Town of Yarmouth ..„ , c ELECTRICAL PERMIT ek<<; fi'�` Job Address: 28 SEMINOLE DR Unit: Owner Name: LEVEE BREAKS INVST GRP LLC Owner's Address: 14 RAINBOW RD Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-15870 Existing Service Amps/Volts Overhead ❑ Underground 0 No. of Meters: New Service Amps/Volts Overhead 0 Underground 0 No. of Meters: Description of Proposed Electrical Installation: Permit to close out expired permit& re-inspection fee. No.of Receptacle Outlets: 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 0 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❑ Ground-Mount❑ Level 1 0 Level 2 0 Level 3❑ Rating: Estimated Value of Electrical Work: $2,000 Work to Start: May 10, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: SCOTT R CONDINHO License Number: 24173 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: W HYANNISPORT, MA, 026720521 W HYANNISPORT MA 026720521 Email: scottcondinho@gmail.com Business Telephone: 508-364-4139 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: l L 6 . C 4'-/ ePE-CebL( RECEI ED �,` /l/� / _-. CommanwsaCth 4 maeksachuos(Ls Official Use Only MAY 1',, it c� {� Pci utit No. (23 �` S 7/' ti 2sparimsnE of g Jsrviesa ,: Occupancy and Fee Checked BUILDING Ut u. ,,;. NT OARD OF FIRE PREVENTION REGULATIONS Rev. I/07I (leaveblarik) By: 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: 51/n!2 City or Town of: fi./zMo u Th 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) 2g 5--,,,,,,,,10,:, /3,2. Owner or Tenant 7),z 9:1 /1 . o '�7`M , i c a ,zinc;-v ;q, ,r Telephone No. Owner's Address 7>' /-jA 4sr S /7,./ e r,✓,e/n,r,cZ c, /rill Is this permit in conjunction witha building permit? Yes El No E (Check Appropriate Box) Purpose of Building Utility Authorization No. (� Existing Service •e Amps ,2 c / -,c Volts Overhead Et Undgrd E No.of Meters v New Service Amps / Volts Overhead❑ Undgrd C No.of Meters I Number of Feeders and Ampacity Locationo and Nature of Proposed Electrical Work: i N i c..w ,,r, ;rt F,t.T •Li s1JL�!,.i r, b =r1 m-rj 1 0• K.:l `L -i. ,T "5OWL l 4. i Completion o f the followinKtable may be waived by the Inspector of Wires. Total N- ll2 No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of � TransformersKVA KVA z Q No.of Luminaire Outlets No.of Hot Tubs Generators KVA �J No.of Luminaires SwimmingPool Above In- No.of Emergency Lighting ( } grnd. ❑ grnd. ® Battery Units �J . No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices IQ No.of Ranges No.of Air Cond. Tans No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained l Totals: Detection/Alertin Devices No.of Dishwashers Space/Area Heating KW Local❑ Co n Connection ❑ Other Connectiaa No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or EEqqu�ivalent _ No. Hydromassage Bathtubs No.of Motors Total HP 'TelecommunicationsofDevior Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 2 ,` . (When required by municipal policy.) Work to Start: s],I Z-, 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 ijiA the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The (i._ ^� undersigned certifies that such coverage� is in force,and has exhibited proof of same to the permit issuing office. 51 1 '// CHECK ONE: INSURANCE LB7 BOND ❑ OTHER 0 (Specify:) Z I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: 5L i-i- ems,,, ,.It,. Signature ,i i/.i/ LIC.NO.: 2-it 7 3.1-, (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:5 Z,:Y-41.;i Address: P.c'; . 13c,,- 24 i,A; ,,1 yynkY . clt r un d Z-C '7Z-^ Alt.Tel.No.: 'Per M.G.L.c. 147,s.57-61,security vdork requites 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 Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts "71 Department of Industrial Accidents kSITARS?' yq, 1 Congress Street,Suite 100 Boston,MA 02114-2017 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/Individual): Address: City/State/Zip: Phone#: Are you an employer?Cheek the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).' 7. ❑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.❑I 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.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 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 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 Cl 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. 1-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#: