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Home My WebLink AboutBLDE-19-000749Owner's Address BELMORE EIJA R, 39 ASTOR WAY, SOUTH YARMOUTH, MA 02664 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: permit to closeout old permit. (Final Inspection) Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.Susp.(Paddle) Fans a Commonwealth of Official Use Only ® Massachusetts PennitNo. BLDE-19-000749 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked of Emergency Lighting Battery Units Rev.l/07 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 INFORMATIOM Date: 8/7/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice ot his or her men ton o per Dari e e cc is work described below. Location (Street & Number) 39 ASTOR WAY No. of Waste Disposers Owner or Tenant BELMORE MICHAEL F Telephone No. Owner's Address BELMORE EIJA R, 39 ASTOR WAY, SOUTH YARMOUTH, MA 02664 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: permit to closeout old permit. (Final Inspection) Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.Susp.(Paddle) Fans No. of Total Transformers V No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In -No. end. rod. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiatiny Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other: Connection No. of Dryers Heating Appliances KW Security Systems:' No of Devices or E uivalen No. of Water KW Beaten No. of No. of SI ns Ballasts Data Wiring: No. of De vlc or E uival n No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail f 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 penalltes of perjury, that the information on this application is true and complete FIRM NAME: RICH M MELVIN Licensee: Rich M Melvin Signature LIC. NO.: 21829 (lfapplicable, enter "exempt" in the license number line.) Bus. Tel. No.: Address: 8 REARDON CIR, S YARMOUTH MA 026641207 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, l hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERAIIT FEE. $50.00 Signature Telephone No. 8181t6 g�El NO €' Commonwealfla olria r/addaac4wef 2epartment ol3iro Sareieed BOARD OF FIRE PREVENTION REGULATIONS official OnlyPermitNo. � r occupancy and Fee Checked LRev.1/07] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MCC), 327 CMR 12.00 (PLEASE PRINT N INK ORTYPE ALL INFORMATI019 Date: SI -71197 City or Town of: 5o � V-+-, �fd..w. rF - To the Inspector of Wires: By this application lire undersigned gives notice cf his or her intention to perform the electrical work described below. LVeation (Street & Number) 39 As Ve,e W OwnerorTenant 6( Telephone No. DJl Owner's Address J3 /,)S Fur I" U4-" Ycrwvr�+' Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization Existing Service _ Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: t L. (jan oc> p -I- Sw, Mn— Corn letiono the ollowin tablent bewaivedb thelnso Moro Wires. No. of Recessed Luminaires No. of Ceil: Sus . addle p (Paddle) Fans 0.0 Transformers KVA No. of Luminaire Outlets No.ofHotTubs Generators INA No. of Luminaires Swlmming Pool nd e ❑ nnd. ❑ o. o mergency g mg Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones o. o etectron an No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges Tota No, of Air Co d. Tons No. of Alerting Devices No. of Waste Disposers eaf ums„_.M!i r_Tn_ Totalp o. o e - ontaine DeteconAertin Devices No. of Disliwashers Space(Area Heating KW unicipa❑ l Other Local [I Conn ection No. of Dryers HeatingAppliances ICW Securstems* or E uivalent No. ofDevlce" o. of atero. Heaters KW of o. o Ballasts Data Wiring: No. of Devices orE uivalent Signs nr e ecommucat' ons irmg No. Hydromassage Bathtubs No. of Motors Total IIP No, of Devices or E uivalent OTHER: Attach adallronal aemu Uaes,reµ ar u.,,�y�••..--��__..- ---. _ Estimated Value of Electrical Work: (when required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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 FJ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties ojperJury, [hat the injormatton on Osis appUcatlonls true and complete. FHi141NAME: tJ ftJSLpW GU. lj (r �6 LIC.N0.-.91 `� Licensee: /) M 2LVity Signature LIC. NO. i—T_1_q� (lf apphcabfe, entggr1' 'ex�emp t��" to the license nw ber line.) �' Bus. Tel. No.•'�r �� Address: 4, /L9/�4t/ONGIFeGI�'JUlttfi y�itraa-rt-f�vl+ byb� A1t.Te1.No.: +Per M.G L. c. 147, s. 57-61, security wor requ res 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 fequired by law. By my signature below, I hereby waive this requirement. I am the (check one ❑owner ❑ owner's a ent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 'Ct ii The Commonwealth ofMassaeltusetis Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Workers' www.massgov/dia Compensation Insurance Affidavit: General Businesses.. TO BE FILED WITH TIMPEl2N'DIN'AUTHORITY. pnlicant Information Ph Isiness/Organization Name: E. F. WINS SLOW PLUMBING & HEATING CO., INC 8 REARDON CIRCLE YARMOUTH, MA 02664 Are you an employer? Check the appropriate box: 1. []✓ I am a employer withi or part-time).* employees (full and/ 2.❑ I am a sole proprietor or partnership and have no employees working for me in any rapacity. [No workers' comp, insurance required] 3. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), and we have 4.0 no employees. [No workers' comp. insurance required], We are a non-profit organization, staffed by volunteers, wrOrno pl°gees. [No workers' comn. Phone #: 508394-7778 Business Type (required): 5. [] Retail 6.QRestauranlBar/BatingEstablishmeat 7. Q Office and/or Sales (incl. real estate, auto, etc.) S. Non-profit 9. Entertainment 10.[] Manufacturing 11.❑ Health Care 12.0 Other "If the corporate otfcers have exwn tr'�-"I""`"'o"`uonbelowshowingtheuworkers•compemationpolicyinroimadon. organiudon should check box #1. p waselves, but the corporation hes Otheremployees, aworkere compensation policy is required and such an I am an employer that is providing workers' compensation Insurance for my employees. Below is thepolicy Information. Insurance Company Name: ARROW MUTUAL INSURANCE COMPANY Insurer's Address: 23 COMMONWEALTH AVE City/State&ip:CHESTN�MA 02467 Policy # or Self -ins. Lic. Attach a copy of the workers' compensation policy declaration page (showing the Polleyumb�ertand expCQA iration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Ona up to $1,500and/or one year imprisonment a d Of ap to $250,00 a day against the violator. Be as well as civil penalties in the form of a STOP WORK ORDER and a fine as that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby eerafy tinder the -;"—j A r-v-•.r.ruw we information provided above true and correct. 1-7 1 Date 508-394.7778 OJJictal use only. Do notwrite irs this area, to be completed by city or town oflleld City or Town: Issuing Authority (circle one): Permit/License # I. Board of Health 2. Building Department 3. City/To 6.Other wn Clerk 4. Licensing Board S. Selectmen's Office Contact Person• Phone