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Home My WebLink AboutBLDE-24-97 1/19/24,6:55AM about:blank Commonwealth of Massachusetts wog • YA �� *Ali. Town of Yarmouth a ,fl ELECTRICAL PERMIT Job Address: 18 NICOLE AVE Unit: Owner Name: OK GUL Owner's Address: 18 NICOLE AVE Phone: Email: Purpose of Building Residential Utility Authorization No.: Is this permit in conjunction with a building permit? Yes Permit Number: BLDE-24-97 Existing Service Amps/Volts Overhead 0 Underground ❑ No. of Meters: New Service Amps/Volts Overhead O Underground❑ No. of Meters: Description of Proposed Electrical Installation: Sub panel 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: ln-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 ❑ Level 2❑ Level 3❑ Rating: Estimated Value of Electrical Work: $ 500 Work to Start: January 13, 2024 FIRM NAME: License Number: Master/System and/or Journeyman Licensee: License Number: Security System Business requires a Division of Occupational Licensure "S" LIC. License Number: Address: Fee Paid: $50.00 Email: Business Telephone: 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: about:blank 1/1 A /)o . /yy7iw��th Official Use Only - C cy iant of it �7 Permit No. (i�f -.�17 -_Y{ .LlePartmant o/ ire Jiroicd `I"'I"";.Li. Occupancy and Fee Checked ,`", ' BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: l I I6 120244 City or Town of: 'larrvnou tin To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) I Q N,i a(G Ave km-'farr»ouKk On Pr 026--A Owner or Tenant y-nCj' Ui— U)` Telephone No. Owner's Address >,SZ ht,iata Ate- w- "(afivm6u4(A YNNIA1�.- 026Z\ Is this permit in conjunction with a building permit? Yes ❑ No L!G (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service kV Amps j ZO/ (ZO Volts Overhead❑ Undgrd Er No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity a a.pe,de a2.S p Icy,Pr c Location and Nature of Proposed Electrical Work:"t p'D(}(,e_ Oka ---c,,csC'JL 'u]t'AA tau (cotX k trice •. Q - K\Ps.J Ccwc€ cr .<i..D et, Lo'i tie,' r,CfAp�� , Completion of the folowingdable mar be waived by the Inspector of Wires. W r/ee-- No.of Total No.of Recessed Luminaires No.of Ceil.Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above in- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. end. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposes Heatump Number Tons KW No.of Self-Contained Totals: Detection/Alertinun Devices Mip� No.of Dishwashers Space/Area Heating KW Local 0 Connection Omer Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: A .4ttach additional detail if desired.or as required by the Inspector of Wires. Estimated Value of Electrical Work: StIO (When required by municipal policy.) Work to Start: 1 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO RA 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 operatic)." •r its substantial equivalent. The undersigned certifies that such coverage is in force,and :> • °/told td%10 • .'t issuing office. CHECK ONE: INSURANCE 0 BOND 0 OTHER I. '•:, : I certify,under the pains and penalties of perjury,that the .rotation i k�im 'n' true and complete. FIRM NAME: del LIC.NO.: Licensee: Signs ,re ,- LIC.NO.: .. ING ULPAR I P48 (If applicable,enter"exempt'to the license number line.) pU1LD -- -- BUT.Tel.NO: Address: Alt.Tel.No.: Per M.G.L.c.147,s.57-61,security work requires Departm •,of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability it sup-nee 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 Telephone No.`l1 4 t>R PERMIT FEE:$ Signature 0 vt alai-1_ Cba Gu,IDK 8 0� VandO, 0Oirt. The Commonwealth of Massachusetts Department of Industrial Accidents t, '�, Congress Street, Suite 100 _4=e Boston, MA 02114-2017 • •:°''� www.mass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please Print LeQibl Name (Business/Organization/Individual): (i u L Ok Address: S lc,. taw '1 M City/State/Zip:�1�, �- `�,� Phone #: -IQ 4'0 Q 6 .9)0' Are you an employer?Check the appropriate box: Type of project (required): 1.— 1 am a employer with employees(full and/or part-time)." 2._ I am a sole proprietor or partnership and have no employees working for me in 7. El New deIjn construction capacity.[No workers'comp. insurance required.] 8. Remodeling 3. I am a homeowner doing all work myself. [No workers'comp_ insurance required.) uir t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will I0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.] 13. Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees. [No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contactors 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: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: C /State/Zip: Attach a copy of the workers' compensation policy declaration page(showing he policy number and expiration date). 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 DLA for insurance coverage verification. I do hereby certij57 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: ,L Phone#' j 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#: