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HomeMy WebLinkAboutBLDE-25-1538 RECEIVED 6' S-LS.3R' _ `' 'UV 1 CaioThonwealth of Massachusetts Official Use Only Permit No.: a'. :•_`u -;1, ;t Department of Fire Services Occupancy and Fee Checked: _li BOARD OF FIRE PREVENTION REGULATIONS [Rev.I/2023] • 1=a APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 City or Town of: YARMOUTH Date: Not/ j3 ,2702..S To the Inspector of Wires:By tl is application,the undersigned giv s notices of his or�Ito,intention to perform the electrical work described below. Beocation(Street Number): I 0 ,A• �i�c S oc [c ci �)�Y Unit No.: Owner or Tenant: Jig�yl11l Ji `iO11 Email: n i%150 n .)IA Q.at:t l oo k .COM Owner's Address: Phone No.: 77'/-366J 2)(c' Is this permit in conju ct�,' n with a building permit/(Check appropriate box)Yes No 0 Permit No.: Zo Purpose of Building: ,v L.) Utility Authorization No.:3 757 Existing Service: Amps / Volts Overhead 0 Underground 0 No.of Meters: New Service: /CO Amps I,9,/) /,.WO Volts Overhead EIUnderground 0 No.of Meters: I Description of Proposed Electrical Installation: 1,(,)i' l S\ OS) /1) t,) R-V U • Completion of the following table may be waived by the Inspector of Wires. No.of Receptable Outlets:66 No.of Switches: 127, Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: I 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-Gmd.0 Above-Goad.0 Hot-Tub 0 No.of Self-Contained Detection/Alerting Devices: 2_, No.Oil Bumers: No.Gas Burners: Video System 0 No.of Devices: No.Air Conditioners: Total Tons: Telecom System 0 No.of Outlets: No.Energy Storage Systems: KWH Storage Rating: Security System 0 No.of Devices: Solar PV KW DC Rating: Solar PV KW AC Rating: No.of Electric Vehicle Supply Equipment: No.of Modules: Roof-Mount 0 Ground-Mount 0 Level 1 0 Level 2 0 Level 3 0 Rating: OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work:JO COO (When required by municipal policy) Date Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: A-1❑or C-1❑LIC.No.: Master/Systems Licensee:see ^ LIC.No.: Journeyman Licensee: l JAtI y LIC.No.: R. r Security System s Business requires a Division of Occupationalal Liccnsure'S",,,✓ 0 LIC. S-LIC./Now: Address: / L C .1) f5 if /�`LI i�J , (4460n/ J/ / Email: no, lk£V 336 agl'lAtl,Coil `�' l,Telephone I cerl fy,under the pains andI pee sallies of perjury,that Nr rfo ma r on I application is true and complete. / ,/ Licensee�f}.j' ..t l,Dt` y Print Name • Cell.No.: '47(r,7(I) INSURANCE COVERAGE:Unles waived by the owner,no permit for the per mance of electrical work may issue unless the licensee provides proof of liability including"completed operation"coverage or its substantial equivalent.The undersigned certifies that such coverage is in force and has exhibited proof f ame to the permit issuing office. CHECK ONE: INSURANCE BOND❑ OTHER❑ Specify: 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 0 Owner/Agent: Tel.No.: Signature: Email.: C.h_e_C h-- 1 q-5 v ?SDS I vo DANIELWI04 MMUSE AC"ORL7 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 11/13/2025 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: Walter J May Ins Agy Inc PHONE 781 749-4310 I FAX 7 188 Whiting St (A/C,No,Ext): ( ) (A/C,No):( 81) 749-1714 Hingham, MA 02043 A oRIESS: info C�WaltermaylnSurance.COm INSURER(S)AFFORDING COVERAGE NAIC# INSURER A :Midvale Indemnity Company 27138 INSURED INSURER B :Twin City Fire Insurance Company 29459 Daniel Wilkey dba Wilkey Electric INSURER C : r-- PO Box 69 INSURER D: Harwichport, MA 02646-0069 INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER: 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 NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDIYYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CP00144964 6/16/2025 6/16/2026 DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENTAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Liability General Aggregate $ MBINED AUTOMOBILE LIABILITY (Ea accident) SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY __ AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION y PER X STATUTE EOTH AND EMPLOYERS'LIABILITY YIN 08WECLB6486 9/10/2025 9/10/2026 100,000 ANY IPROPRIETOER/ PARTNER E ECUTIVE N NIA E.L. EACH ACCIDENTOFF $ (Mandatory in NH) E.L. DISEASE-EA EMPLOYEE $ 100,000 If yes, describe under 500,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE WV-VU4^{11P1.07 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD $ COMMONWEALTH OF MASSACHUSETTS DIVISION O' OCCUPATIONAL LICENSURE * BOARD OF ELECTRICIANS ISSUES THE FOLLOWING LICENSE { REG JOURNEYMAN ELECTRICIAN Ict' DANIEL 0 WILKEY 168 CENTER ST SOUTH DENNIS, MA 02660-3744 1C\� 32288 E 01/3112028 765673 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER