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Home My WebLink AboutBLDE-23-19975 12/6/23,2:18 PM about:blank Commonwealth of Massachusetts of . s * �.a Town of Yarmouth z o O ELECTRICAL PERMIT Job Address: 12 MILL LN Unit: Owner Name: LUCEY DAVID LUCEY ALICE Owner's Address: 32 BROOK ST Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? No Permit Number: BLDE-23-19975 Existing Service Amps/Volts Overhead El Underground ❑ No. of Meters: New Service Amps/Volts Overhead❑ Underground❑ No. of Meters: Description of Proposed Electrical Installation: Install generator 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 De i s< Swimming Pool: In-Grnd.0 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 ❑ 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 El Ground-Mount❑ Level 1 0 Level 2❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 7,258 Work to Start: December 6, 2023 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: ANDREW M LEVESQUE License Number: 17318 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: HARWICH PORT, MA, 026461831 HARWICH PORT MA 026461831 Fee Paid: $50.00 Email: permits@hchpllc.com Business Telephone: 508-432-3259 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: about:blank 1/1 Commonweal h o/�aeeachuedffta Official Use Only (-�3 — r 'i c� Permit No. l I[r a 2).parfmsnl o/.hire&rvicei �( di Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONSki,r,.., [Rev. 1/07] (leave 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: f .- City or Town of: pro( -,,. To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1 a. }ry); c\ Lc.r\-e, ,...(tccvv z, , ._- Owner or Tenant Lv `Q Li Telephone No. Owner's Address � 5 St- �s �C .' f ) 11rn(n I C 41`/(� —� i Is this permit in conjunction with a building permit? Yes ❑ No IR (Check Appropriate Box) Q.::J Purpose of Building Utility Authorization No. Existing Service Amps 2L ) / Volts Overhead❑ Undgrda No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters 5 Number of Feeders and Ampacity 1.41-•- Location and Nature of Proposed Electrical Worki-Ke fia,et , ("a, y,0 ko,I u, ,,C( ts) -1' ',i Completion of the following y table m be waived by the/ for of Wires. v: al U.: No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans No.of or ,; Transformers KVA �t No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above ❑ In- ID No.of Emergency Lighting grad. grad. 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 Initiating Devices l No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons _ KW_. No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Mal 0 other Conaechunicipion 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 Wirfn : No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 7,.)s g- .c) (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 BOND 0 OTHER 0 (Specify:) I cernfy,under the pains and penalties of perjury,that the information on this application is true and complete. q t FIRM NAME:44-LeK,W 1(A-I"rOpi° 4A-11 N(7-t- CO-0 LI NS LIC.NO.: irl7 PI4 C)74- Licensee: !kNN2.4iA1 (kV-Cs&Lit Signature IC.NO.: (If applicabl,enter"exempt"in trhelic�ense number line.) 12, .. c-l in. Address: Li-{rj I L,NYE f2 C/ lA N`l"1A t2 ) RAJ lt'-I OI2T rn4 11, t lt.'CeLl.No.• *Per M.G.L.c. 147,s.57-61,securitywork + ° "Alt.TeL No.: 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 0 owner's agent. Owner/Agent I Signature ,a� Telephone No. - - - I PERMIT FEE:$ { i ne c,omrnunweuun of iviussucnusens Department of Industrial Accidents y ' Office of Investigations - , I'=' Lafayette City Center '—'A'''� 2 Avenue de Lafayette, Boston, MA 02111-1750 y � www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):Harwich Port Heating & Cooling Address:461 Lower County Road City/State/Zip:Harwich Port/MA/02646 Phone #:508-432-3959 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 85 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. ElBuilding addition [No workers' comp. insurance comp. insurance. required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself workers' comp.m seright of exemption per MGL Y [No12.E Roof repairs insurance required.] t c. 152, §1(4),and we have no HVAC employees. [No workers' 13.E Other comp. insurance required.] *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: Selective Insurance Company Policy#or Self-ins. Lic. #:WC9059813 Expiration Date:10/26/2024 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 t ains and enalties of perjury that the information provided above is true and correct. Signature: Date: . Phone#: 508-432-3959 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): tOBoard of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Phone#: Contact Person: