Loading...
HomeMy WebLinkAboutBLDE-19-001442 4110. +' Commonwealth of Official Use Only ifMassachusetts Permit No. BLDE-19-001442 ‘," BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.1/07) 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:9/11/2018 City or Town of: YARMOUTH To the Inspector of Wirer By this application the undersigned gives notice of his or her intention to pertorm the eiestucal work described be ^ �^ Location(Street&Number) 7 RAYMOND AVE CT6S gel j4_ Owner or Tenant JOLY ALEXANDREA M Telephone No. Owner's Address GARDNER VANESS E,7 RAYMOND AVE,SOUTH YARMOUTH,MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (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: Replacement water heater. 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 Arbdv0 Ignr-nd. ❑ No.of Emergency Lighting g 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. 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 ❑ Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water 1 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 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 El (Specify:) 1 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 ( otzi/bert- f ~ l a �/J� hzte ---,--------- Official Lim Only � r ommonwea o ///oAdac eiGl pi cy� C� permit No. .tie arlmanE o Jiro Jerald F Occupancy and Fee Checked °^ z BOARD OF FIRE PREVENTION REGULATIONS [Rev.1107] peaveblenk) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),5 7 C 12.00 (PLEASE PRINT IN INK ORTI'P ALLINF Tli\Date: 9 c /3 UI City or Town of: To the Inspector of ires: By this application the undersigned gives n ice of his or her intentio to perform the electrical work described�below. N Location(Street&Number) 7 f2fob2D c C C_____cel Owner or•Tenant /OsEPH 'nisi— Telephone No..77 Owner's Address 5n#14.- Is this permit in conjunction with a building permit? Yes ❑ No u (Check Appropriate Box) Purpose of Building 'OC4'u1/V6r Utility Authorization No. . Existing Service_ Amps ' / Volts Overhead❑ Undgrd❑ No.of Meters __ New Service _ Amps / Volts Overhead El Undgrd 0 No.of Meters __ . - Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: //UPI(2-1C- ale/ g " IJ6-197"5"" W Completion of the followin•table mbe waived b the ins ector o Wires. No.o Total -*•:, No.of Recessed Luminaires No.of Ceil.Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.otrmergency Ligh ni O No.of Luminaires SvvimmingPool end ❑ grad. ❑ Battery Units 3 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. TotalTonaNo.of Alerting Devices No.of Waste Disposers eat ump umber Tons,_I{,W No.of Self:Contained _ Totals: Detection/Alerting Devices Municipal Oilier• No.of Dishwashers Space/Area Heating KW Local❑ Connection fleeting Appliances KW Security Systems:* No.of Dryers g No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices Oi uivalent Telecommunications Wiring: No.HydromassageBathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail ifdesire4 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. l INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless trLthe 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 0 OTHER 0 (Specify:) • I certify,under the pains and penalties ofperJury,that the information on this application is true and complete. FIRM NAME: :'c tO NSLoW .t. 3 Co d" t ' Al 1:4 ', ' LIC.NO.: r K LIC.NO.:r9192`/9 Licensee: tt 'e M t1.1110)n Signature de Bus.Tel.No:...___--- 0 �, ��s�� �, (Ifappllcnble,ent��• exan•t'inthelicensenw:berline.) Address: - L' It ION ftC! tilt ¢� Gir i ti l� ' 0 /� A1t.Te1.No.:�-- *Per M.O.L.c.147,s.57-61,securitywor requires Department of Public Safety"S"License: Lic.No. (gyp 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 0 owner's a ent. N Z Owner/Agent PERMIT FEE: $ kl 0 Signature Telephone No. U • a -- • '`1 1 e_ �,p�--©© The Commonwealth ofMassachusetts aa ' 5,t Department ofJndustrialAceidents 6 want:: 1 Congress Street,Suite 100 ' tt St:JJ=e. Boston,MA 02 11 4-2 01 7 :4o+ www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses.. TO BE FILED WITH THE PERMITTING AUTHORITY. A e •licant Information Please Print Le.iibl 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: i.12 I am a employer with Business Type(required): . or part-time).* employees(full and/ 5• 0 Retail 2.0 Iamasole proprietororpartnersh6. QRestauraaf/Bar/EatingEsblishment •• employees working any pand haveno 7. Q Office and/or Sales(incl.real estate,auto,etc.) ktntororP incapacity. 3.0 [No workers'comp.insurance required) 8. 0 Non-profit We are a corporation and its officers have exercised 9. Q Entertainment • their right of exemption per c.152,§1(4),and we have 4.0 no employees.[No workers'comp.insurance required)** 10.Q Manufacturing We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees.[No workers'comp. "�Yapplicant with hatno ohecks boxploye pl must insurance req.) 12.0 Other *'IIthaeorpomteoffuershave exempted also fill out the section below showing their workers'compensation policy information. **If the corporate should box ex p�themselves,but the corporation has other employees, awarkers'compensatlon policy is required and such an 1. ' I am an employer that is providing workers'compensation Insurance for thy employees. Blow Is the policy Information.ARROWMUTUALINSURANCECOMPANYInsurancaCompnyName: Insurer's Address;23 COMMONWEALTH AVE City/Stateigip: CHESTNUT HILL,MA 02467 Policy#or Self-ins.Lie.#1821A ExirationAttach a copy of the workers'compensation policy declaration page(showing the policy nu berate: 01/20and 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 line 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. Idohereby eertf 1 ,enaltleso ' " perjury that the information provided above is true and correct. Si_nature: ` ...w a....a hone#: 508-394-7778 Date: r] Official use only. Do not write in this area,to be completed by city or town officio( • City or Town: Issuing Authority(circle one): • Permit/License# 1.Board of Health 2.Building Department 3.City/Twn Clerk 4.LlcensingBoard 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/din