The URL can be used to link to this page

Home My WebLink AboutBLDE-26-635 Commonwealth of Massachusetts Official Use Only, -, Permit No.: r?C, ,- ��C� J 1--E _(1 Department of Fire Services Occupancy and Fee Checked: •.al:gel— BOARD OF FIRE PREVENTION REGULATIONS 1 p 1 _ 1 Rev. 1/2023 7 __ %' 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: 4/27/2026 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): 9 Kristen Path Unit No.: � Owner or Tenant: Owner Mt Ap z 6 0,S e t N{ Email: mgelectricservice@gmail.com Owner's Address: 62 Nick Rd Middlebury Ct 06762 Phone No.: 860 670 6419 Is this permit in conjunction with a building permit?(Check appropriate box)Yes❑ No❑■ Permit No.: Purpose of Building: Residential Utility Authorization No.: 26148766 Existing Service: 100 Amps 120 /240 Volts Overhead Ej Underground❑ No. of Meters: 1 New Service: 200 Amps 120 /240 Volts Overhead® Underground El No.of Meters: 1 Description of Proposed Electrical Installation: Remove existing 100 amp service and replace with a new 200 amp service 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:3 KW:5 No.Water Heaters:1 KW:5 No.Transformers: Total KVA: Space Heating KW: Heating Equipment KW: No.Motors: Total HP: Total KW: No.Ileat Pumps: Total KW: Total Tons: Fire Alarm System y ❑ No.of Devices: Swimming Pool:In-Gmd.❑ Above-Gmd.El 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 El 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: 900.00 (When required by municipal policy) Date Work to Start: 5/9/2026 Inspections to be requested in accordance with MEC Rule 10,and upon completion. FIRM NAME: MG Electrical Services LLC A-1 ❑or C-1 ❑LIC.No.: Master/Systems Licensee: Michael Gobstein LIC.No.: 0191369 Journeyman Licensee: LIC.No.: Security System Business requires a Division of Occupational L.icensure"S"LIC. S-LIC.No.: Address: 62 Nick Rd Middlebury Ct 06762 Email: mgeiectricservic@gmail.com Telephone No.: 860 670 6419 I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Licensee: Michael Gobstein Print Name: Michael Gobstein Cell.No.: 860 670 6419 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 insurance 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,1 hereby waive this requirement. I am the:(Check one)Owner El Owner's agent❑ Owner/Agent: Michael obstein Tel.No.: 860 670 6419 Signature:_ G,i /.i[O(% f ? 374 Email.: ACC1R S DATE(MMIWDIYYYt" CERTIFICATE OF LIABILITY INSURANCE 4/27/2026 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 LORI ACT NAME: ADamarie Hynes Insurlyox,LLC PHONE FAX is No,Ex* (203)528-4015 (FZ.No): 401 Monroe Turnpike Suite 8 DNELas: ahynco inourIyox.com INSURER(S)AFFORDING COVERAGE NAIC C Monroe CT 06468 INSURER A: Guard Insurance INSURED INSURER B: MG Electrical Services LLC INSURER C: 62 Nick Rd INSURER D: INSURER E: Middlebury CT 06762 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. LTAN TYPE OF INSURANCE ruitiLesut IN30 WND POLICY NUMBER (zee YYI')(MUMIOD/yyL.y) LEHiS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 S CLAMMADE OCCUR PREMISES(Ea omm $ance) 50,000 MEDEXP(Any one person) $ 5,000 A _ MGBP654442 08/31/2025 08/31/2026 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMaIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT OLOC PRODUCTS-COMP/OP AUG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY CONWINEO CINULE LIMIT $ ANY AUTO (Eaaccident) BODILY INJURY(Per poison) $ OWNED —SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per aaidan0 $ HIRED —NON-OWNED AUTOS ONLY _AUTOS ONLY (Per EHIYnI)AMA(aE $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS4JAOE AGGREGATE $ DEO f ,RETENTIONS WORKERS COMPENSATION PER Orbs- AND EMPLOYERS'LIABILITY (STATUTE I lee - AND PROPRIETOR/PARTNERWA.ECUTIVE YIN $ OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT (Mandatory In NH) If yes,describe under EL.OI9FACP_EA EMPLOYEE$ DESCRIPTION OF OPERATORS bobs./ — ELIVSFASP_POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks SWmdWs,may be attached N more eaece Y molded) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Yarmouth THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 2$ AUTHORIZED REPRESENTATIVE Q.+M ..-s,. o.r S Yarmouth MA 02664 01988.2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF CONKE( TICUT 1)L P 1 R 7:iir\ 7 (I1 CQa:S'I i11:R PROTECTION ELECTRICAL UNLIMIT ED CONTRACTOR MICHAEL_A GOBSTEIN 62 NICK RRD MIDDLEBURY, CT 06762 License # Effective Expiration ELC.01 1 69- 7 .10/11/2025 09/30/2026 f s - }+t f SIGNED gi.lc�s�___�_._F" f( v,I'v '�. yi State of Connecticut H titY{2 ;1'# Workers' Compensation Commission A L. , .) M V � Please TYPE or PRINT IN INK rK Proof of Workers' Compensation Coverage when Applying for a Building Permit for the Sole Proprietor or Property Owner who WILL NOT act as General Contractor or Principal Employer APPLICANT FOR BUILDING PERMIT �`7'`JCJc�{//QQ Name of Applicant for Buikflng Permit L� 1s 4�4S�' zu Property located at 9 y J5m favv- in the City/Town of ATTEST If you are the owner of the above-named property or the sole proprietor of a business doing work on the site of the construction project at the above-named properly and you WILL NOT act as the general contractor or principal employer,you are not required to have workers'compensation insurance coverage. CHECK ONE(1)BOX ONLY and complete the following: Q I am the OWNER of the above-named property.I WILL NOTact as the genera/contractor or principal employer. Signature of OWNERApplicant am leA tho SOLE PROPRIETOR ore business doing work at the above-named property.I WILL NOT act as the general contractor or principal employer: • Name of Business_ M^ 1„ ?4e"/ 6C'7 eOO/t/—sc2, T: 2 it Federal Fmptoyerll#(FEIN) I f) ti 2 f V.—5% 'mac-1/ L�c i v L c� Signature of SOLE PROPRIETOR Applicant _y2 From: Michael Gobstein mgelectricservice@gmail.com Subject: Information/applacation Date: May 4, 2026 at 9:09AM 1:,„„? To: KElliott@yarmouth.ma.us Ken My wife and will be living at 9 Kristen permanently on or before August 1st 2026 Mike Please let me know you have this note.Thank you 0 Outlook Re: Information/applacation From Michael Gobstein <mgelectricservice@gmail.com> Date Mon 5/4/2026 6:41 PM To Elliott, Ken <KElliott@yarmouth.ma.us> 1 attachment(493 KB) 2026-05-04_184000.0f; 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. See attached. > On May 4, 2026, at 9:09AM, Michael Gobstein <mgelectricservice@gmail.com> wrote: > Ken > My wife and will be living at 9 Kristen permanently on or before August 1st 2026 > Mike > Please let me know you have this note. Thank you