HomeMy WebLinkAboutBLDE-25-1544 IECtf ) 1
OCT 161015 :
Commonwealth of tvassachusetts Official Us Only1
B U l l , Permit No.: 6-a,,S- 54 r
Department of fire Services Occupancy and Fee Checked:
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023]
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: South Yarmouth Date: 10/16/25
To the Inspector of Wires:By this application,the undersigned gives notices of his or her intention to perform the electrical work described below.
Location(Street&Number): 38 Indian Memorial Drive Unit No.:
Owner or Tenant: George Poulakos Email:
Owner's Address: 11 Ashland Street Medford Ma 02155 Phone No.:
Is this permit in conjunction with a building permit?(Check appropriate box)Yes® No❑Permit No.:
Purpose of Building: Residence Utility Authorization No.: 23162092
Existing Service: 100 Amps 125 /250 Volts Overhead® Underground❑ No.of Meters: 1
New Service: 200 Amps 125 /250 Volts Overhead® Underground❑ No.of Meters: 1
Description of Proposed Electrical Installation: Upgrade service from 100a to 200a
Completion of the following table may be waived by the Inspector of Wires.
No.of Receptable 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-Grad.❑ Above-Grad.❑ 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 ❑ Level 2❑ Level 3❑ Rating:
OTHER:
Attach additional detail if desired,or as required by the Inspector of Wires.
Estimated Value of Electrical Work: $3000.00 (When required by municipal policy)
Date Work to Start: 10/14/25 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
FIRM NAME: Coleman Electric Inc A-1 ®or C-1 ❑LIC.No.: 1486 Al
Master/Systems Licensee: David Coleman LIC.No.: 17221
Journeyman Licensee: DFavid Coleman LIC.No.: 29607
Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.:
Address: 62 Fleetwood Path Marstons Mills Ma 02648
Email: coelect@comcast.net Telephone No.: 508-364-8456 —
I certify,under the pains and penalties of perjury,that the information on this application is true and complete.
Licensee: David Coleman Print Name: David Coleman Cell.No.: 508-364-8456
INSURANCE COVERAGE:Unless waived by the owner,no permit for the performance 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 of same to the permit issuing office.
CHECK ONE: INSURANCE® BOND❑ OTHER❑ Specify: Liability
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❑ Owner's agent❑
Owner/Agent: Tel.No.:
Signature: Email.:
160 - ( C 1 h 1��
9,2 ,, Outlook
Returning call Into Coleman Electric Inc
From Dave Coleman < coelect@comcast.net>
Date Wed 10/15/2025 9:07 AM
To Elliott, Ken < KElliott@yarmouth.ma.us>
Attention!: This email originates outside of the organization. Do not open attachments or click
links unless you are sure this email is from a known sender and you know the content is safe. Call
the sender to verify if unsure. Otherwise delete this email.
Hi Ken :
I got your cal on the way home from off cape. I tried you a couple of times this morning but
recording both times and punched in your name but back to the recording . Anyway, Im taking a
guess why you called . At 38 Indian Memorial Drive an electrician was to do the paperwork for
an upgrade of service from 100 a to 200 a . and the plan to install a second floor was scheduled .
Well , when I got on board the second floor was started . I got wind that the gable where the drop
was attached had to be removed and they were going to just hang the existing 100 a service.
With the roof half off I went to get a temporary and set it. I attached the widget to the temporary
but not disconnected from the house at this time. I pulled a temporary electrical permit and
asked if I could just pull back and get the temp connected . He was inspecting it but it had to be
connected before he came. This was not to eliminate a permit fee but hanging the service while
ladders around I felt this would be obviously is sure hazard . All 38 years in business other than
reconnecting a service after a change I never felt the reason not to go through the steps to take
over the responsibility of the power company. I told them to bill the temporary fee , but I know
this shouldn't have been done not really my problem , but safety was the cause of quick thinking .
On the way off cape yesterday I received a call from an engineer and blasted me rightly so to
leave their responsibility alone and I agreed regardless the reason . I set the 200a socket but
that was it. I will bring a permit down later or tomorrow for the upgrade. I hope I didn't cause
problems with the assistant inspector, but I didn't just do it I thought no harm in asking .
Sorry I didn't get you via phone yesterday but went off cape and returned around six. Call
needed . 508-364-8456
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I .3 ( '15
ACCPREP CERT., CATE OF LIABILITY INSURANI,_, DATE(MM/DDYYYYY)
06/23/2025
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($).
PRODUCER CONTACT Tina Reeves
NAME:
The Hilb Group New England,LLC PHONE (800)640-1620 WCPAX
lNC No.Extl: ,No):
A�bL ADDRESS: treevesfithilbgroup com
973 lyannough Road INSURER(S)AFFORDING COVERAGE NAIC
Hyannis MA 02601 INSURER A: Travelers Casualty Insurance Co of America 19046
INSURED INSURER B: Safety Indemnity Insurance Co 33618
Coleman Electric,Inc. INSURER C: Travelers Property Casualty Co of America 25674
62 Fleetwood Path INSURER D:
INSURER E:
Marston Mills MA 02648 INSURER F:
COVERAGES CERTIFICATE NUMBER: CL255838274 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 AUUL - POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INED VIVO POLICY NUMBER (MM/DDIYYYY) (MMIDDM'yn LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED 3000
I CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 0,0
— MED EXP(Any one person) $5,050
A 6808F495217 05/01/2025 05/01/2026 PERSONAL 8,AW INJURY $ 1,000,000
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY❑JEGa Ei LOC PRODUCTS-COMP/OPAGG $2,000.000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO vBODLY INJURY(Per person) $
B OWNED SCH SCHEDULED 5938749 02/07/2025 02/07/2026 BODILY INJURY(Per emdent) $
AUTOS ONLY
X AIRED NON-OWNED (Per accident)
PERTY DAMAGE
AUTOS ONLY AUTOS ONLY
Uninsured motorist BI $ 100,000
sse UMBRELLA LIAR OCCUR EA EXCCH ORO CC"URRENCE $3,000,000
C EXCESSLILIA�B CLAIMS-MADE CUP8F511178 05/01/2025 05/01/2026 AGGREGATE $3.000.000
DED I XI RETENTION$5,000 5
WORKERS COMPENSATION I PEATUTE I Pr
-
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE El N/A E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED'!
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S
H yes,desmbe under
DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATORS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required)
Operations performed by the named insured subject to policy conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of.Attn:Electrical Inspector ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
®1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
�t The Commonwealth of Massachusetts
,�, Department of Industrial Accidents
9 ,! : '' ' Office of Investigations
k = Lafayette City Center
s I 1..,,,,\-\
2 A venue de Lafayette, Boston, MA 02111-1750
--4!.:. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Legibly
Business/Organization Name: Coleman Electric Inc
Address: 62 Fleetwood Path
City/State/Zip: Marstons Mills Ma 02648 Phone #: 508-428-7445
Are you an employer? Check the appropriate box: Business Type (required):
1 . U I am a employeesemployer with (full and/ 5. LI Retail
or part-time). * 6. El Restaurant/Bar/Eating Establishment
2. 011 I am a sole proprietor or partnership and have no 7. 111 Office and/or Sales incl. real estate auto etc.)
employees working for me in any capacity.
workers' com . insurance required] 8. ❑ Non-profit
[No p
3. ❑ We are a corporation and its officers have exercised 9. [II Entertainment
their right of exemption per c. 152, § 1(4), and we have 10. ❑ Manufacturing
no employees. [No workers' comp. insurance required]**
11 . ❑ Health Care
4. ❑ We are a non-profit organization, staffed by volunteers,
with no [Nocomp re.em to ees workers' . insurance .] 12. 0 Other Electrical installs plus repairs
p Yreq.]
applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information.
**If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an
organization should check box # 1 .
I am an employer that 1S providing workers' compensation insurance ft)r my employees. lefow is the policy information.
Insurance Company Name: AIM MUTUAL INS_ CO
Insurer's Address: PO BOX 4070
City/State/Zip: BURLINGTON MA 01803
Policy # or Self � . Lic # AWC40070329242022A _ . irati Date: be08/022
.Attach a coPYo �eworkers compensation policydeclaration page (showing e policynum
Failure to secure coverage as required under § 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 the pains and penalties of perjury that the information provided above is true and
4Z
correct S i ature: Date: 10/16/2 5
Phone #: 508-364-8456 38 Indian Memorial Drive
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):
1.[]Board of Health 2.0 Building Department ID City/Town Clerk 4.❑ Licensing Board
50 Selectmen's Office 6. [}Other
Contact Person: Phone #:
wv,mass,gov/dig.
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