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Home My WebLink AboutE-18-6081 . Commonwealth of Official Use Only ( Permit No. BLDE-18-006081 Massachusetts BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked rRev.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 INFORMATION) Date:5/1/2018 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 electrical-work described below. Location(Street&Number) 191 NORTH MAIN ST Owner or Tenant SURPRENANT WILLIAM Telephone No. Owner's Address 191 NORTH MAIN ST,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 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters r>n. Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Air conditioner 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 CI In e ❑ P: No.of Emergency Lighting grnd. grnd. 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 Initiatine 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 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:" No.of Devices or Eon ivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs 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 u 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 til r• fr ?t fie ie 6e)- Q ) CmntonweagL of Massachusetts Official Use y tGPemilt No. 8 r1` yoParinenio1iro�ewrcae :f9.,•-,.-,=-.;..."' I-ei Occupancy and Fee Checked n. a� 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 Co(de(MEC),527 CMR 12.00 (PLEASE PRINT IN INK ORTY/PE ALL INFO TION ate: y i' ZC7 i I City or Town of: lag/100T 7% 7i1k�o the Inspector of Wires: By this application the undersigns gives notice of h' or her ntention to perf.r-t- Owner m the electrical work described below. L'o'cation(Street&Number) li a is a r ✓L I ,-1 .1'1. -/��56 Owner or Tenant 13I ' i j Ci- Telephone No. Owner's Address 19 1 IVO 1 N 6(p 111 to-Ft • Is this permit in conjunction with.a building permit? Yes El No El (Check Appropriate Box) Purpose of Building b it e I t [l 0) 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: ,Y/ ,e- c% flfl7oxi.✓f -53'.f'o''n Com.letiono the ollowin:table ma bewaived b the Insot'ro Wires. No.of Recessed Luminaires No.of Ceil.-Sus .(Paddle)FansTrof (-�, p Transformers KVA CD No.of Luminaire Outlets No.of Hot Tubs Generators KVA 0 Above In- No.ai Emergency Lrgh m� T No.afLuminaires Swimming Pooled ❑ grnd. ❑ Battery Units c' 1p No.of Receptacle Outlets No.of Oil Burners FIR ALARMS No.of Zones .h No.of Detection and sy..J a_ 0 No.of Switches No.of Gas Burners Initiating Devices r f-.15No.of Ranges No.of Air Cond. TotaloNo.of Alerting Devices —� No.of Waste Disposers eat Rt.r Pump ,_umber,.Tons__, TSV_, No.of Self-Contained Totals: Detection/M Municipal rtin eDevices .-1 No.of Dishwashers Space/Area Heating KWLocal 0 Connection 0 Other Security S stems•* rj No.of Dryers Heating APPTrances No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: —11No. TCW Si, s Ballasts No.of Devices or E uivalent .-1 e ecommunications r'irm No.Ilydromassage Bathtubs No.of Motors Total HP 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 Er BOND ❑ OTHER ❑ (Specify:) • • I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. ' FIRM NAM: r tt.) �fostenJ • U. 3 • 4" tie e • CP LIC.NO.: -37B'1 C.- (� / / LIC.NO.:a018?T4' • Licensee: t r"ex(Ln M.21,WnJ Signature ! Bus.Tel.No:428.3 9�'7 e (If applicable,snitr"exem.t"in the license nugtber line.) Address: - L JL•10N tiiC6- Oltu ;at//, 4 A ' 0 A'6''' Alt.Tel.No.: *Per M.C.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 tequired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ 4) 1011 Ce .. t 1 The Commonwealth ofMassachusetts �= 1 "Department of Industrial Accidents e 1 Congress Street,Suite 100 Boston,MA 02 11 9-2 01 7 www massgov/dia Workers'Compensation Insurance Affidavit:General Businesses.. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. phone#:5O8-394 7778 Are you an employer?Check the appropriate box: Business Type(required): 1.Q 1 am a employer withal__employees(full and/ 5. 0 Retail or part-time).* 2,0 I am a sole proprietor or partnership and have no 6. Q Restauanv ori ating Establishment 7• 0Office 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 are a corporation and its officers have exercised 9. 0 Entertainment • their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing 4.0 no employees.[No workers'comp.insurance required?* We are a non-profit organization,staffed by volunteers, 11.[]Health Care with no employees.No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers havb exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#l. I am an en ployer 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.Lic.#1821AExpiration p Attach a copy of the workers'compensation policy declaration page(showing the policynate:number and 0 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 forrrr 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 cert! the'ajits and r enaldes o perjury that the information provided above is true and correct. • Signature: 2 -1 • Date: l� j�l phone#:508-394-7778 Official use only. Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person. Phone#: wwwmass.gov/dia