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HomeMy WebLinkAboutBLDE-25-1675 1 RECEIVED o2 -�(�7. :ommonwealth of Massachusetts Official Use Only __K-___1 Permit No.: 25 Department of Fire Services Occupancy and Fee Checked: , V_ =°1 BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/2023] BUILD -, _- RTMENT By .. APFtICATION 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: /t/ .6-/ 12,5' 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): 3 0 I t A E I410 (1t IV- bRt V I , Unit No.: Owner or Tenant: e 0 2:e 0 v l` {t0, Email: Owner's Address: 11 ,45f/ A N .jL Me tr+ met 02l Sr Phone No.: S 141- - 2 92 -4 63-Z Is this permit in conjunction with a building permit?(Check appropriate box)Yes M No❑ Permit No.: 61 b a _?s-y6, Purpose of Building: 5(N 9 it �0 AA F. Utility Authorization No.: • Existing Service: ZOO Amps JZD/240 Volts Overhead[ Underground❑ No.of Meters: 4 New Service: Amps / Volts Overhead❑ Underground❑ No.of Meters: Description of Proposed Electrical Installation: tk i k t io ike. HOUSE- Completion of the following table may he waived hi'the Inspector of Wires. No.of Receptable Outlets: 30 No.of Switches: 15 Generator KW Rating: Type: No.Luminaires: No.of Recessed Luminaires: No.Wind Generators: Wind KW Rating: No.Appliances:14 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 0 No.of Devices: Swimming Pool:In-Grnd.❑ Above-Grnd.0 Hot-Tub❑ No.of Self-Contained Detection/Alerting Devices: No.Oil Burners: 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❑ Rating: OTHER: Attach additional detail if desired,or as equired by the Inspector of Wires. Estimated Value of Electrical Work: I6'',5 7 `" (When required by municipal policy) • Date Work to Start: .1 Z//5-/ t2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: .F Mice-Lc. is N ilX0 LL4- A-1 ❑ or C-1 0 LIC.No.: Master/Systems Licensee: LIC.No.: Journeyman Licensee: le 5 LIC.No.: I 312 O -. 6 Security System Business requires a Division of Occupational Licensure"S"LIC. S-LIC.No.: Address: E(LD BR II 14 O 2 < <� Email: 4 11 ilA,6111x. ? G/'0)& ( • coot Telephone No.: 6(7- `I 3 a "9575 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: l 3 q 2D--e Print Name: c.k ie God 4,/(bt Cell.No.: 677_C158_957E 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 s e 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❑ Owner/Agent: Tel. No.: Signature: Email.: j. . ?sos fit; • i; •N, , s . . . . .-.-:COMMONWEALTH OF MASSAtialUSETTS :. --•- •,. • ' ''. ..: DIVISION OF PROFESSIONAL LICENSURE L•i - •:!.:!- . '..- :::: *.:' — :.... ... . :TARO : • I r . .. • - EtxtrkiciAN9 - ...-- .:,s::::,-,: ,.,:,, ,: is' i . :::,':'• ISSUES THE FOLLOWING LICENSE AS A REGJOU b — . 'ONEYMAN ELECTRICIAN .... ...„..,= i,. ENKELED NIKOLLA :. .: •., ' - .'" -4." • . . 40 SKYLINE DR APT 10 BRAINTREE, MA 021044.10& , 13920 ,. .::r;.:'.'•07131/2019 . . .::.: 103408 M . ,...., um LICENSE NUMBEREXPIRAT10t4 DA T:E SEjLIA_. NUg._._R_:__.__:,-; .... . . . . .. - •:. • -�-� NIKOENI OP ID: TA ACIC:WE," DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/03/2025 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 781-356-3533 CONTACT Tara Kenney NAMEL Richenburg Insurance PHONE 781-356-3533 FAX 781-356-3532 Agency Inc (A/C,No,Ext): (NC.No): 25 Garden Park ii RREss:tara@richenburginsurance.com Braintree,MA 02184 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Ins Co INSURED INSURER B: Enkeled Nikolla 9 Devon Road INSURER c: Braintree,MA 02184 INSURER D: 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WYD IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR NPP6103995 09/05/2025 09/05/2026 DPREAMAMGEISES(Ea rgENTEoccurreDnce) $ 100,000 _ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1'000'000 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTEO�S ONLY AUTOS BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per ccident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y f N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept For job at: AUTHORIZED REPRESENTATIVE 38 Indian Memorial Drive South Yarnouth, MA 02664 '� n� x-Q-� ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD