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Home My WebLink AboutBLDE-19-001441 Commonwealth of Official Use Only It Massachusetts Permit No. BLDE-19-001441 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/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 (PLEASEPRMT IN INK OR TYPE ALL INFORMATIOM Date:9/11/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice or his or her intention to perform the electrical work described below. Location(Street&Number) 8 MILLARD RD Owner or Tenant MIGLIORE STEPHEN TRS Telephone No. Owner's Address MIGLIORE M DEBORAH TRS,28 RIDDLE DR,BEDFORD,NH 03110 Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install receptacle&relocate range receptacle. 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 Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting grnd. grnd. Battery Units No.of Receptacle Outlets 1 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number I Tons KW No.of Self-Contained Totals; - ) Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 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 Siena 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 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 (1 c�sr2 mw,rlrn. Nb W0042-- WAS-Ac e Vzt/(8�nfr A p q/� r Official Use Oat Ca nmana ee o�/r/assachu�s(f2 {�Sl(� ( 49 ( �t ccyy .c77 (C�� Permit No. l:J [ . 1 AVE 1=: .UeParfineni'o�Jire Jervice9 __�V E Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ey 1/07] �• ,.,., [R (leave blank) — • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 'C),527 i' 12.00 It (PLEASE PRINT IN INK ORTjPEALL INFORWA TION) Date: . City or Town of:gveir,vinf)1'h (,Snt To the Inspector o Wires: By this application the undersi d gives •lice o his or r int,tion dI g perform the electrical work described below. Location(Street&Nu. her) ,IT 14 ' I to _ so . , I'�-�p Owner or Tenant e - } 6�� ,' ' ` Telephone No.4i! "'7•�I I Owner's Address , : reMn nI ra t . i ----- Is this permit inconjnn tion with a puilding permit? Yes I No 0 (Check Appropriate Box) W Purpose of Building' tOe / i f et Utility Authorization No. •M Existing Service_ Amps ' / J Volts Overhead 0 Undgrd 0 No.of Meters " t^^1 New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters __ '''•• Number Feeders and Proposed city I , •` 'la� .ae. Location and Naturr�e of Prop.sed Electrical Wor : .y�� .�... 1,n_ 11 it llIPPalal 'V Corn.lettono the ollowin:table ma bewaived b the Ins.ectoro Wires. o.o o S No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers EVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- 'No.ofEmergency lighting No.of Luminaires Swimming Pool , ad. ❑ :rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection an. 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 •eat'ump `umber -ons _, No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ElCMonnectiounicipal n 0 Other Appliances -Security Systems:* Heating No.of Dryers g pI No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: M Heaters Sins Ballasts No.of Devices or E•uivalent • I elecommunicatrons iring 00 No.IlydromassageBathtubs No.of Motors TotaNHP No.of Devices or Equivalent I— OTHER: f Attach additional detail if desired or as required by the Inspector of Wires. p0 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. Q— 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 Fil BOND 0 OTHER 0 (Specify:) • I certify,under trate pains and penalties of perjury,that the information on this application/s true and complete. FIRM N ui r Et) tO5Lotd , . . . a- {{�' 0 j2`to CP . ' LIC.NO.:_, l� Licensee:( tGMtZf Mourn) Signature ,,t/ " LIC.NO.:(22/ff2l ' (Ifnppltcnble,enbr 'exem•t"In the license num rber line.) Bus.Tel.No.: 508 Address: " L' 'V /ON gat vu, A t/NOtb 14 ihi ' O7-bh' Alt.Tel.No.:.--___— *Per M.G.L.c.147,s.57-61,security wor 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)0 owner ❑owner'snn Owner/Agent I PERMIT FEE:$5� 1_ Signature Telephone No. O' I 4 - • _? t The Commonwealth of Massachusetts t t Department of lndustrialAccidents • 1 Congress Street,Suite 0 -Org.FI= Boston,MA 02114 2017 :;n, www.mass.govldia Workers'Compensation Insurance Affidavit:General Businesses.. TO BEETLED WITH THE PERMITTING AUTHORITY. A. .'leant Information 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#:508394-7778 Are you an employer?Check the appropriate box: Business Type(required): 1.[✓ I am a employer with 10 employees(MI and/ 5. 0 Retail or part-time).* 6. QRestaurant/Bar/BatingEstablishment • 2.0 I am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. 0 Non-profit 3.0 We area corporation and its officers have exercised 9. 0 Entertainment . their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing no employees.[No workers'comp.insurance required]** 11.[]Health Care 4.0 We are a non-profit organization,staffed by volunteers, • with no employees.[No workers'comp.insurance req.) 120 Other *Any applicant that checks box 81 must also fill out the section below showing their workers'compensation policy incarnation. **If the corporate officers have exempted themselves,but the corporation has other employees,aworkers'compensation policy is required and such an organization should check box 41. I am an employer that is providing workers'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.Lb.41821 A Expiration Date:01101120(q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MCL 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi :• the and,.enakies o perjury that the information provided above Is true and correct Signature: 7° `` �v i..s Date: )a. L.31 /i°7- phone#:508394.7778 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.Licensing Board S.Selectmen's Office 6.Other Contact Person: Phone#: wwa.masv.gov/dia