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Home My WebLink AboutBLDE-16-004263�Fc� 11433 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-16-004263 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (9 [Rev.t/071 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: 1/26/2016 City or Town of. YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice ot his or her intention to pertomi e e ectrica work described below. Location (Street & Number) 361 GREAT ISLAND RD Owner or Tenant SWEAT MICHAEL D Telephone No. Owner's Address SWEAT RITA P, 91 SPOFFORD ST, GEORGETOWN, MA 01833 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Wiring for solenoid valve Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp.(Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. grnd. No. of Emergency Lighting Units No. of Receptacle Outlets —Battery No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatiniz Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons I KW No. of Self -Contained Detection/Alertine Devices I No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of Water KW Heaters No. of No. of Si ns Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring. No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to start: Inspection to be requested in accordance with MEC Rule 10, and upon completion. 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. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC. NO.: 21829 (If applicable, enter 'exempt" in the license number line) Bus. Tel. No.: Address: 8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires Department of Public Safety "S" License: OWNER'S INSURANCE WAIVER: I am aware that the License does not have the liability insurance coverage normally required by law. But signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Aeent Signature Telephone No. PERMIT FEE. $50.00 Commonwea& of i"i%aemackwetb Official Use Only cc�� cc77 f 1Z Permit No. `P~ 2rtmeepant ol..i'ire Services Qccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INF RMATION) Date: 61 b ( ( City or Town of: To the Inspector of Wires: By this application the undersigifed gives notice of his, or he intend to erform t e electrical work described belo Location (Street & Number) ��Gl _G �i _ -s I n 1 o 6 Owner or Tenant Owner's Address Is this permit in conjunction with7building permit? Yes ❑ Purpose of Building d� Telephone No. N) 6 — No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ Number of Feeders and Ampacity > Location and Nature of Proposed Electrical Work: Vi rl No. of Meters No. of Meters Comnletion of the followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Sus . le Fans P ( ) Padd o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimmin Pool Above ElIn- ElIN g rnd. rnd. o. o Emergency tg ►ng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. InDetection and of Initiatin Devices No. of Ran Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pum Totals: Number Tons KW * *............ No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal ❑ Other Connection of Dryers Heating Appliances KW Sec uriNo. No of D Devices or Equivalent No. of Water Heaters KWI No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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. CHECK ONE: INSURANCE Ef BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAM, } g 1� ti,..ijtll.�Lot,; L(f 1 4- f� G`i T L„U LIC. NO.:. Licensee: (L,1 C -4 -Az -j) M t; ix io Signature ke- LIC. NO.:9I 67;t` /� _ (lfapplicable, enter exempt" in the license number line.) VBus. Tel. No.: Address: I ,tLZ"—A�fe) LitfZa6 5oit14 qA-CliyarH, Al-" Oj44' Alt. Tel. No.: *Per M.G.L. c. 147, s. 57-61, security work requires 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)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 'IG -03q 6 60 Dov` 0o. 4 1673V �O asrz �.viawicvac rr c.wccic arJ ara wuuwa-er wusccu Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): F-lli�• �j+,\51 Oen.+ �[UyJE Address:�(ae- V City/State/Zip: ",Sc,s k -i t4A- Phone #: "50S- 1' 7'� Are you an employer? Check the appropriate box: I am a employer with -70 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors '. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their �. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other 1ny applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. /} tsurance Company Name: l n—T,, :-'� i f1j U Ck? e h✓�� i olicy # or Self -ins. Lic. #: isai A Expiration Date: � —1 - x('31_% )b Site Address:.2.3 ( , Clea � W�l City/State/Zip: d,) L4 fps 7 ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne 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 Fup to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of westivations66 the DIA for insurane"overaize verifKa on. do hereby certify un e erins an penalties o pe fury that the information provided above }is true and correct. iunafi?ca�-_ 9 ' .. TiatP r 1 [ I aokbr hone #• S11-1 14 - 7.179 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 #: 2/11/2016 Document Category Map -Block Number Street Number Street Name Department Parcel ID Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time SlipGen - Portal Home Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg39793] Building Permits 014.2 0361 GREAT ISLAND RD Building 93 No Operator, Yarmscan 2016-02-11 - 09:11 http://laserfiche12/SlipGerV 1/1