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Home My WebLink AboutBLDE-24-595 4/11/24,6:45 AM I about:blank Commonwealth of Massachusetts =~ov • y4 ''.. Fur* Town of Yarmouth ELECTRICAL PERMIT . Job Address: 20 BLISCOTT AVE Unit: Owner Name: ALBERINI ASHLEY K Owner's Address: 259 GREAT WESTERN AVE UNIT B Phone: Email: Purpose of Building Residential Utility Authorization No.: 1 Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-595 Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters: C New Service Amps 200/Volts Overhead 0 Underground❑ No. of Meters: ro+-"/ Description of Proposed Electrical Installation: New residence �j ' �'7 7 �/� 3 � '�c'y �, P `�`�' l v�." V 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 ❑ 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❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 23,000 Work to Start: April 20, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: DANIEL E DICESARE License Number: 21275 Security System Business requires a Division of Occupational Licensure "S" LIC. Lice er: "` Address: MIDDLEBORO, MA, 023463065 MIDDLEBORO MA 023463065 ee Paid: $180.00 Email: dand.electric@verizon.net Busi •508-697-8185 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: 1-ett2510.11,6 t 963 26 c-- 7( B-t-(ki :,614)0 etLs .5-(3(.1(2A.< 1--,-5 1 tP 2tic , (A(t7(vi &#‘ c axtet, 1 c i.t .i V ' L C(tfa'-zet g about:blank 1/1 F i .O. OD 14 Commonwealth of !/Iassachcr9s(is Official Use Only cam, S� 5 �- , 3ep €o!giro-Services ! Permitto. (-- s [ Occupancy and Fee Checked ' ' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave bleak c _ ' } ° APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M .527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALLORMlTION) Date: V /O City or Town of: Yarrv,ou To the inspector of it P By this application the undersigned gives notice of his or her intention to perform the electrical bed below,, �y Location(Street&Number) ,�Q Si L i .l"r"T.T A V� , 1 APR 1 l J 2024 Owner or Tenant 073? Grea.r \r.rc.S e•ri, AD Ya.r,�o u irk Te lepno No. v.v. !p'sAddress —`0.n0'6OLLaa' Cu5Ta,vif BUILDING DEPARTMENT it Is this permit In conjunction with a Yes No 0 (Cheek Appro e lu Purpose of Building .foil..‘ Fermi t 1 Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd El No.of Meters New Service e/0 0 Amps a 0/ a?Y4 Volts Overhead 2r. Undgrd❑ No.of Meters Number of Feeders and Ampacity Ll Location and Nature of Proposed Electrical Work: w;R,n► e fF a /l c w GO/l j r rc rc 1 c'i 1-1°0Sc c..i TA nr !~ Gar 6c ? fr aLt, a Terms 1 .Se,r,i ce- v-, O Completion o(r a follenvinittrak ntuy be waived by the 1 of Wires, l No.of Recessed I No-of Cell.-Soap.(Paddle)Fans Transformers KvA No.of Lumtne Outlets No.of Hot Tubs Generators KVA No.of Latmiaairec Swimming Pool Above 1-1 In- r-i INC of emergency Lighting grad grad Battery Units '^J No.of Iecephnie Outlets No.of Oil Burners FIRE ALARMS No.of Zones 'No.of Detection sad z"' No.of Switches: No.of Gas Burners Initiating Devices tal i i t No.of No.of Air Cond. Toons- No.of Alerting Devices T Waste 'Rest Pump Number Toes _'KW--.-"No of Self-Contained No.of Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal connection Q (loser 4 No.of DryersHeating APp� KW Security Systems:* No.of Devices or Equivalent No.of*raise 'No.of Ra.of Hems KW Signs Baliaris Datallo.ofDevices or E. No.-Hydremassage Bathtubs >No.of Motors Total HP Tel o of Deve�na e ; 1 N No.of�or l,nuiv OTHER: Attach additional detail if denim arras requited by the Inspector of Wires. Estimated Value of Work: a 3,00 C (Whetrregt required by municipal policy.) Work to Start: ' 0 Inspections to be requested in accordance with MEC Rule ICI,and upon completion, INSURANCE GE: 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 is in force,and has exhibited proof of same to the permit issuing office, CHECK ONE: INSURANCE GI BOND 0 OTHER 0 (Specify:) I cerritir,; the pains and penalties aidit ofperfi py,that the information on this applicatha is true and cow FIRM NAME: U Qnd ' F LeCTr:C LLC LIC.NO..: eR I a75 q 1.)a r,;c L. E Th.( Cc Sage Signature c 4.ru,.Q eh; .0 LIC.NO.: 516:£2,E (ifavplkable,otter'exempt"in the license number line.) j Bus.Tel.No.. 1 Address: G6 ELK Run rc MIfzsoLeizorc. PIA c) 3Vf6 ?8 �.7 51?o *Per M.G.L.c. 147,s.57-61, workAlt.TeL o ,S 6 -- $I S security requires Department of Public Safety"S"License: I.ic.No. �S C�~�iQ O 1 3?3 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not havethe liability insurance coverage normal y requited by law. By my signature below,I hereby waive this requirement. I am the(check one)El owner 0 owner's agent Owner/Agent Signature Telephone No. I PERMIT FIE;$ _ The Commonwealth of Massachusetts ► #—L ,II. Department of Industrial Accidents __ , _� 1 Congress Street, Suite 100 ti,=_1f` Boston, MA 02114-2017 =,�0 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lesribly Name (Business/Organization/Individual): fl a r,A 1= Le c r v C. L L C. Address: 66 ELK Zi 0 10 R City/State/Zip: 11 +cc. Le,y,ac-o /il A p 3y 6 Phone#: _o 8 6 9? g_l 5- Are you an employer?Check the appropriate box: Type X project(required): l. /1 am a employer with 3 employees(full and/or part-time).* 7. 511 New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. 0 Demolition 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insuance.t fb.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other I152,§1(4),and we have no employees.[No workers'comp.insurance required.] 1 *Any applicant that checks box#1 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: I r a v e. L Cr- . S Policy#or Self-ins.Lic.#: t - 13 9 6 i R --a! 1 q - y a Expiration Date: to �1� / i / a y Job Site Address: do J(i'S (ofT A\le 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. t I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: o&4'l.k ')' cz/Lc'"u- Date: VAD it2111 Phone#: �a g 6?7 R i g Offccial 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#: