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Home My WebLink AboutBLDE-18-007018 �'oil�i� Commonwealth of Official Use Only teMassachusetts Permit No. BLDE-18-007018 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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:6/11/2018 k City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electcatwork described below. Location(Street&Number) 9 CADET LN Owner or Tenant BROWN DENISE Telephone No. Owner's Address 9 CADET LN,WEST YARMOUTH,MA 02673 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 0 Undgrd ❑ No.of Meters New Service Amps Volts Overhead 0 Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Ductless NC install. 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 KVA No.of Luminaire Outlets No.of got Tubs ,Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o No.of Emergency Lighting grnd. grn . 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 Initiating Devices No.of Ranges No.of Air Cond. 1 Total :No.of Alerting Devices Tons No.of Waste Disposers Heat Pump - Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts 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: 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 0 BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties 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 (If applicable,enter"exempt"in the license number line.) Bus.TeL No.: Address:8 REARDON CIR, S YARMOUTH MA 026641207 Mt.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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. (PERMIT FEE:$50.00 1 M Q�//]]�� II s er 7l Commonwealth of lltddacaadelt6 a 0 „ t cy �r Permit No. Mt- -(J aparlmsrtt o/.ire Jervlced +_��z. 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(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALLORNIATIO Date: �� City or Town of: UJ.Qc- Ain u 4-i To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Lineation(Street&Number) q C. o f Loin eC Owner or Tenant 1J?d11Se ¶/O Wyk. Telephone No. c6ti l 146 ) Owi i:r's Address 5itWI t Is this permit in conjun 44on with a building permit? Yes 0 No Er (Check Appropriate Box) Purpose of Building (JUDY 1(t Vt q Utility Authorization No. Existing Service_ Amps Volts Overhead 0 Undgrd❑ No.of Meters __- New Service _ Amps / Volts Overhead ID Undgrd❑ No.of Meters . Number of Feeders and Ampacity • Location and Nature of Proposed Electrical Work: I. 1- ' A Com.letiona the ollowin:table in' be waived 6 the Ins rector Wires. . �o.of Dial No.of Recessed Luminaires No.of Ceil.Susp.(Paddle)Fans Transformers EVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool _ ❑ o.o mergeney r: g ' , love ❑ rn . . Batter Units - No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones - ' No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges • No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons );! No.of Self-Contained Totals: DetectionlAlertingDevices ❑Municipal ohm No.of DishwashersLocal Space/Area Heating KW Connection ❑ -Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water Heaters KW o.oi�f No.of Data Wiring: Ballasts No.of Devices or E'uivalent St' s a ecommunications c icing No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desirec4 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 [I BOND 0 OTHER 0 (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application Er true and complete. FIRM NA : Pc It) NSCow U . t•' r - 'r LIC.NO.: . �— i . LW.NO. I-1 S✓1A tr., rs, , Licensee: Nal-MI) M2zVlry Signature _ Bus.TeLNo:40_ �� (lf applicable,ent- "aunt"in the license n tber line.) yl' CT �� Address: r L.1DN lot Ulc 1v At/id 0 i me b b_ Alt.Tel.No.:---- +Per M.G.L.0.147,s.57-61,security wor requires Department of Public Safety"S"License: Lin No. ej- OWNER'S INSURANCE WAIVER: I am aware thatthe 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 0 owner 0 owner's a ent. Owner/Agent • PERMIT FEE:$ Signature Telephone No. • • • 1 The Commonwealth of Massachusetts l1 r— j= t Department of Industrial Accidents �_;$1,f� 1 Congress Street,Suite 10O 1-- Boston,MA 02114-2017 Workers' www.massgov/dia Compensation Insurance Affidavit;General Businesses.. A1Ilieantlnformation TO BE 'JUDW1T1jvERmIrrENG AUTHORITY. Please Print Le ibl Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. phone#;508-394-7778 Are you an employer?Check the appropriate box: 1.El I ama employer with- BusinessType(required): or part-time)• �— employees(full and/ S. 0 Retail 2.0 I am a sole proprietor or partnership6. ❑RestauranUBar/Eat ng Establishment employees working for me in any capacity. no [No workers'comp,insurance required] 8. 0 Office and/or Sales(incl.real estate,auto,etc.) 3.0 We are a corporation and its officers have exercised Non-profitm • their right of exemption per c.152 1 4 and we have 9 0 Manu Entertainment no employees. insurance ( )' 10.0 Manufacturing 4.0 We are anon-profit organization,staffed a ffedb cerequee s, with no employees. staffed by volunteers, I l.0 Health Care [No workers'comp.insurance req.] 12.0 Other • *Any applicant that checks boxfilex must also fill out the section below showing their workers'compensation policy int`oimation. **Wale should check exempted themselves,but the corporation has otherem to ee aworkers'com compensation policy**Waecorpobouldeheck box if! p y 4 P P Y• required and such an l am an employer that Awayidingworkers'compensation Insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 • • Policy#or Self-ins.Lie.#1821A ate: 47 Attach a copy of the workers'compensationpo]icydeclarationpage (showtng ion heptolcynumber0and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification Ido hereby cerci renalties o perjury that the information provided above is true and correct. Si.nature: ' shone#•508-394-7778 Date: Official use only. Do not write to this area,to be completed by city or town official City or Town: Issuing Anhorlty(circle one); Permit/license# 1.Board of Health 2.Building Department 3.Cyd Ion Clerk 4.Licensing Board 5.Selectmen's Office 1.Other Contact Person; Phone#: wWmass.gov/dia I w