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Home My WebLink AboutBLDE-24-652 4/22/24,3:21 PM about:blank Commonwealth of Massachusetts . of• yA� *4 Town of Yarmouth iw ELECTRICAL PERMIT v � A�Hr Job Address: 11 APACHE DR Unit: Owner Name: KUNHARDT DANIEL B Owner's Address: 11 MADISON CIR Phone: Email: Purpose of Building Residential Utility Authorization No.: 17126572 Is this permit in conjunction with a building permit? No Permit Number: BLDE-24-652 Existing Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters: New Service Amps/Volts Overhead ❑ Underground ❑ No. of Meters: Description of Proposed Electrical Installation: Upgrade service (100-to 200 Amp) 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 ❑ 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 E Level 2❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 1 Work to Start: April 22, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: SHERWOOD E LEWIS License Number: 11503 Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: Dennis Port, MA, 026390699 Dennis Port MA 026390699 Fee Paid: $50.00 Email: lewis-electric@hotmail.com Business Telephone: 508-280-9533 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: Imo]F'� 4(,mac (mil rf about:blank 1/1 Commonwealth.o`1r/aeda,L 4ette Official Use Only "f ccyy ��'7i Permit No. 't— `6S7� L _'V .).partment o/..tirs Saraicee ''=�)i-- Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] ( eate) f 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:gri'i l 22/1o2+ City or Town of: `►f�f llI oN�� To the Inspector of Wires: y By this application the undersign gives notice of his or her intention to perform the electrical work described below. .: Location(Street&Number) ' I A tD c.e,1h e- D f i ve �(I G�MO H'17,jJ e/ /4• �7 S Owner or Tenant D a ittJJ.0 1 f1A1-0 �elephone No. Owner's Address I I /�*ge.Chf' Dri✓•e YaPMo01.11rci M,l,D2f71 Is this permit in conj ction(with a building permit? Yes ❑ No ® (Check Appropriate Box) y Purpose of Building hoM C Utility Authorization No. I 1210 5 2 d Existing Service [0 0 Amps I'2-0/(2 Q Volts Overhead ra Undgrd❑ No.of Meters �f New Service rZ0 G Amps ]20/ 120 Volts Overhead Overhead® Undgrd❑ No.of Meters Number of Feeders and Ampacity sj�y�e �hhs[ Location and Nature of Proposed Electrical Wor (kr 1(2il< S et-✓'t C v (- )00.L C c 1 I-e l.re'ie 1 fio 2. OD Afty-r, VI Completion of the following table may be waived by the bmector of Wires. Ui No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers TKVA 1; Q No.of Luminaire Outlets No.of Hot Tubs Generators KVA k Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones and Z. Initiatingof Devices IQ No.of Ranges No.of Air Cond. Tons) No.of Alerting Devices No.of Waste Disposers Heat Pump Number.Tons _K_W_ No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Munnectio n thericipal ❑o Con No.of Dryers Heating Appliances KW 'Security Systems:* No.of Devices or Equivalent No.of Water No.of No.of Data Winn Heaters KW Signs Ballasts Na o eet�arcc��oor-,q�t slept No.Hydro massage Bathtubs No.of Motors Total HP Telecom WTI: Wrong D No,of Devices or Equivalent OTHER: APR 2 2 1 Attach additional detail if desired,or m Peptised by me Inspector of Wires. Estimated Value of Elec ical Work: (When required by municipal polio y.) IJI.DING DEPARTMENT Work to Start: LI 22 Inspections to be requested in accordance with MEC Rule 1 ,,.and ttgon_completion. ___ INSURANCE VE AG : 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 certify,under the pains and penalties ojperjury,that the Information on this application is true and complete. FIRM NAME: --��jj/�� LIC.NO.: Licensee: k(1.-04 L(..Qwrj Signature`�� <Ja",,Gb LIC.NO.: 115 (Ifapplicab! enter"eum t". a ease berl'e.J Bus.Tel.No.• Address:p().1,JOyC�7 7 yeas, err ,t21,3 y Alt.TeL No.: *Per M.G.L.c.147,s.57-61,security wo requ 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)0 owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ ( 0 v' c) The Commonwealth of Massachusetts I , E !l, Department of Industrial Accidents '— 1 Congress Street, Suite 100 `' la, T'" 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): S hemp() c Le 1,,, c[ 1 Address: P 0 t% ) (a 61, ► , is,. t ff.02 7 City/State/Zip. :,—`�.;: ` ' . Phone #: So 20- C/S3 3 Are you an employer?Check the appropriate •'x: 1 Type of project(required): I.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.4 I 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. [ Demolition 3.0 I am a homeowner doing alI work myself. [No workers'comp. insurance required.]t 10 n Building addition 4. I 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. 12.0 Plumbing repairs or additions 5.E I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.n Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other 5- eft./ 152,§1(4),and we have no employees. [No workers'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: O CeaA s I C J'$tJ f .'1 C e- Do,,,e Policy#or Self-ins.Lic. #:'jpp*396((,Sg 7 bgwEc 806, Expiration Date: 12./ 'VIZ 0 2.'/ Job Site Address: 1 I P QC�,e, O cive. City/State/Zip:`(G(•/ho+J�'�j �]!' if�1 - 9J� Attach a copy of the work�rs' compensation policydeclaration page(showing the policynumber and ir0ndate . P P g P ) 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 certi under the pa' s and penalties of perjury that the information provided above is true and correct Signature: C i �v Date: /./2-2772-4 Phone#: �- O rf5 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#: