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HomeMy WebLinkAboutBLDE-25-1281 forrrno,.wca_ii_of/ila:sac1.:43c� t: Oiiciai Use Only -.L5 -' w___ — c�arto5:e Cr"a:. f 4cc6 , Occupancy and Fee Checked BOARD OP FIRE PREVENTION REGULATIONS tRev. 1/07] (leave bleak) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accord2nce with the Massac1nsens Elecoical Code(lvlEC),527 CMR 1100 (PLEASE PRINT IN INK OR TYPE ALL 1NFOR1,14T101v) Date: - 8— a-S. City or Town of: YARMOUTH To the Inspector of Wires: By this application the unde:`simed gives nod of his or her intention to perform the elecLLi; wordescribed below. Location(Street&Number) ( 0,•-) ,*-it.._J e \4:2 kQ Owner'or Tenant )NV CO S w CAA•L Telephone No. Cs?1/471-- C — 0 t L. Owner's Address ) /N t 'Q— Is this permit in conjunction with a b lding permit? Yes L No I ., (Check Appropriate Bo) ) Purpose of Building 6 U.9 Q (,,r tr Utility Authorization No. / jq Existing Service IC) 0 Amps (:)-'- /J OVolts Overhead I— Undgrd L_ No.of Meters l New Service Amps / Volts Overhead E Undgrd ❑ No.of Meters Number of Feeders and Ampacity �.Gtr� A-k. Location and Nature of Proposed Elact-icsl Work: AL. ,fC-G.(F� �)-12- `'� 'C' ' Uj-k,t).J.i,i,_ 0 i-k_.V y Completion of the following table may be waived ay the Inspector of Wires. 1No.of Recessed Lurninair•es '_No.of CeiT.-Snsp.(Paddle)Fans No. Total•. • o.of Luminaire Outlet t,No.of Hot Tubs Generators IVA No.o - �.'ttaires Swi-mming Pool Above 7 In- Q kNo.of rmera-- • Lighting arc& :end. (Battery II No.of Receptacle : --e:s No.of Oil Burners 'I'I. -- ALARMS iNo.of Zones No.of Switch •.of Gas Burners o.of Detection and Initiating Devices No.of Ranges tNo.of Air .. To No.of Alerting Devices No.of Waste Disposers Heat Pump IN-umber -" • KW No.of Self-Contained y Totals:1 Detection/AIerting Devices No.of Dishwashers SpacefArea = :flag KW . Munieipal p�., �Connection � Odrer • No.of Dryers IHeati• Appliances KW Sect' stems:' t• .. of No.of �. No.of :ces or Equivalent No.of Water Heaters KW Data Whin;. Signs Ballast No.of Devices or Equivalent t INo. Fiydromassage Bathtubs No. of Motors Total FiP 'Telecommunications Wiring: t No,of Devices or Equivalent OTHER: 1 to e - o� Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work'. 4/00 (When required by municipal policy) Work to Start: Inspections to be requested in accordance with MEC Rule I0,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 ❑ OTHER ❑ (Specify:) I certij51, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: `c, G:LeC-C@.D_ .60. i4. i( LIC.NO.: 1 t%pllr(9 ) 'Licensee: • L�- LA.:L.,(0 Signature � A LIC.NO. 3 L . (If applicabl enter"exempt"in the licenser bet line. ) Bus.Tel.No.: 6 - -•re 77� . Address. 04X- 1100 CAD .Ct}ikZ1iRl-/ M.Pr 1 O 2`76c( Alt.Tel.No.: g-a�7�52 n d} 1 "`Per M.G.L.c. 147,s.57-6I,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAFVER: 12m aware that the Licensee does not have the liability insurance coveragerage n----o`_ S required by law. By my signature below,I hereby waive this requirement I am the(check one)0 owner ❑owner's agent. y Owner/Agent al Signature Telephone No. I PERMIT FEE: $ DATE(MM/DD/YYYY) AC RDA CERTIFICATE OF LIABILITY INSURANCE 12/10/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Sandra Hartman Acrisure New England Partners Insurance Services, LLC PHONE 203-699-4500 FAX Acrisure New England Trust tart.No.Ext): (A/C,No): P.O. Box 24717 ADDRESS: shartman@Acrisure.com New York NY 10087-4717 INSURERS►AFFORDING COVERAGE NAIC# License#:BR-1796561 INSURER A:Merchants Mutual Insurance Company 23329 INSURED LINGELE-01 INSURER B: Ling Electro Mechanical LLC J. Roger Ling INSURER C: PO Box 1200 INSURER D: W. Chatham MA 02669 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1769195722 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY BOPI076455 11/24/2024 11/24/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY MCA1001779 11/24/2024 11/24/2025 COMB aBINEDtSINGLE LIMIT $ (EaX ANY AUTO BODILY INJURY(Per person) $20,000 AWNED SCHEDULED BODILY INJURY(Per accident) $40,000 AUTOS ONLY AUTOS X HIRED x NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCA1033977 11/24/2024 11/24/2025 PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED'? N/A (Mandatory in NH) If yes,describe under E E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Property BOPI076455 11/24/2024 11/24/2025 Personal Property 55,125 Deductible 500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Associates, Inc. 345 Massasoit Road Eastham MA 02642 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25*(2016/03) The ACORD name and logo are registered marks of ACORD