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Home My WebLink AboutBLDE-19-002185 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002185 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.1/071 i 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:90/12/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives nonce of his or her intention to perform the electrical-work described below. _ Location(Street&Number) 50 JOYCE ST Owner or Tenant WELCH MARY E Telephone No. Owner's Address 2302 PINEWOOD DR,SMITHFIELD, RI 02917 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 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. 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 ❑ in- CINo.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 1 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Watery 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 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 (Ifapplicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CR,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 ..- o A /� A� r�/� I 0 ciallXse Only l ornmanwealth o/rr/addacL dead 2t 8 l Ct Thepartm4nt Permit No. `E b of Jiro.SeruiceQ t i IF r Occupancy and Fee Checked — o 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 C10.1 0 (PLEASE PRINT IN INK OR TYFEALL INFORMATION) Date: r (1U City or Town of: )Q,f al004-1/1 To the Inspector of' fres: By this application the undersigned gives notice of his or her intention to •-rform the elestrical work described below. Lwation(Street&Number) c . y ' iter 4- ' , I 4k Q • r 2 � Owner or Tenant V t ' fP7a Telephone No. Owner's Address S fn tr✓)Q, Is this permit in conjunction withbuilding permit? Yes ❑ No (Check Appropriate Box) Purpose of fuilding ' O w er' dl ¶J Utility Authorization No. Existing Service_ Amps ' / Volts Overhead 0 Undgrd❑ No.of Meters __ New Service _ Amps / Volts Overhead El Undgrd❑ No.of Meters ___ Number of Feeders and Ampacity / t Location and Nature of Proposed Electrical Work: G a 5 150111:1- Ins -1-a 1-10 1r u/n Com•letiona the ollowin:tabllein, be waived b the Ins sector o Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA AbIn- `No.of Emergency Lrgh mf g No.of Luminaires Swimming Pool ndove. ❑ : nd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones , No.of Detection and- No. ndNo.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices g No.of Waste Disposers Heat Pump Number.,Tons IOW_ No.of Self-Contained P Totals: Detection/Alerting Devices Municipal No.ofDisliwashers Space/Area Heating KW Local Connection 0 Other No.of Dryers Heating Appliances KW security Devices y g PP No.of Devices or Equivalent No.of Water No.of Ni.of Data Wiring: Heaters KWSignsBallasts No.of Devices or EquiyalT ent Telecommunications Wiring. No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: • Attach additional detail ifdesire4 or as required by the Inspector of Wires. c, 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. LnINSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless Cr- r' • - the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The Q t —t-- undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. V:r' Ci" CM CHECK ONE: INSURANCE Ed BOND 0 OTHER 0 (Specify:) , t,P Q I cert,under the pains and penalties of perjury,that the information on this application is true and complete. C j FIRM NAME: c 0OSLoto •,. Loh el' ef 14 '0 • LIC.NO.: _�j "C.- Llcensee:�IC(kf)(LQMfWi,1 Signature LIC.NO.r�IS,?`Ift 9— • (Ifapplicable,ent- "exermt"inthe license n berline.) I Bus.Tel.No:�a I Address: - ' ' ION (ECU 'vu bit 'a • 0 bk Alt Tel.No.: *Per M.O.L.c.147,s.57-61,security war 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 fequired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 I owner's agent. Owner/Agent I PERMIT FEE:$ Signature Telephone No. ti, • • The Commonwealth of Massachusetts tr-mnifiT lDepartment of IndustrialAccidents 1 Congress Street,Suite 1005 _ Boston,JILT 02114-2017 ',;t� www massgov/dia Workers'Compensation Insurance Affidavit;General Businesses.. TO BE FILED WITH THE PERMITTING AUTHORITY, Applicant Information Please Print Lean*/ 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 employees(full and/ 5. 0 Retail • or part-time).* 2.0 I am a sole proprietor or partnership and have no 6. ❑Restaurant/Bar/EatingEstablishment 0 7. 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 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, 11'0 Care with no employees.[No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box 81 must also fill out the section below showing their workers'compensation policy infoimation. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box fI. • ' I am an employer Mans 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.Lie.#1821A ExpirationAttack a copy of the workers'compensation policy declaration page(showing the policy number and expiation 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 • the ai S and renalttes o perjury that the information provided above is true and correct Si: azure: a--.-y A - I Date: . Phone it:508.394-7778 Official use only. Do not write In this area,to to completed by city or town official City or Town: iPermit/Iicense#Issuin Authority(circle • • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board S.Selectmen's Office 6.Other Contact Person: _ Phone#: WWW.mass.gov/dia —