The URL can be used to link to this page

Home My WebLink AboutBLDE-19-002092 ^/J Commonwealth of Official Use Only iE Massachusetts Permit No. BLDE-19-002092 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.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:10/9/2018 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) 4 CAPSTAN RD Owner or Tenant CLAYTON THOMAS F Telephone No. Owner's Address CLAYTON BARBARA C,4 CAPSTAN RD,WEST YARMOUTH,MA 02673 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 0 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 furnace. 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 II Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0 In- LINo.of Emergency Lighting G 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 ❑ Municipal 0 Other: 'i Connection No.of Dryers Heating Appliances KW Security Systems:* t No.of Devices orEauivalent No.of Water KW No.of No.of Data Wiring: , Heaters Signs Ballasts No.of Devices or Eauivalent 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 (Ijapplicable,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 LNSURANCE 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 Sel,X (0i idt8 kEt_. •-r ,. AA�� fficialUseOnlyCoi &of Mea1achU [[ie `�7 ./l�� "- M Permit No. l-___ _ t=s fbeparfmant o/Thra Jervicea Occupancy and Fee Checked'r= ,=.t • '",,,7:73;,„, BOARD OF FIRE PREVENTION REGULATIONS [Rev.1./07 .1c • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),S27 MR 12.00 (PLEASE PRINT IN INK ORTIZALL INFOyhfATIOIV) Date: /VJ City or Town of: afir Oti •• To the InspecorofWires: • By this application the undersigned giv s notice. his or her in -ntion to.erfo . the-lectrical wor described below. . Location(Street&TNumber) • t r tt t k J -Sd S• l o Owner or Tenant lin CIA.(I do Telephone No. Owner's Address Stolle Is this permit in conjuion with a building permit? Yes ❑ No (Check Appropriate Box) ri t . Purpose of Building • vaIbi. 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: 66 FlarriRf9 j` n4ft ' I , • Com.letlono the ollowin:tableIna bewaivedb the Ins sector o Wires. • ota No.of Recessed Luminaires No.of Ceii.-Sus .(Paddle)Fans o.of p Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- 'No.of Emergency Lighting No.of Luminaires SwimmingPool grill 1--1 grnd. ❑ Battery 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 , umber_Tons-,-_.1 ,_, No.of Self-Contained P _ Totals:I I I .Detection/Alerting Devices nicip No.of Dishwashers Space/Area Heating KW Lout❑ CMonunectiaonl ❑ other No.of Dryers HeatingAppliances KW Security Systems:* Y PP No,of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent dromassa dBathtubs No.of Motors Total HP TelecommunicationsNor Equivalent ng: No.H Y g o.oYDevicesorEquivalent • OTHER: Attach additional dealt!ifdesireri or as required by the Inspector of Wires. \./, 0 Estimated Value of Electrical Work: (When required by municipal policy.) iz:p ten 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. fD %.,71 Q CHECK ONE: INSURANCE Ei BOND 0 OTHER 0 (Specify:) `J I certify,under the pains and pantiles of perjury,that the information on this application is true and complete. FIRMNA r tt) tO5Loto •I. . <- a eid, - t,0 • • LIC.NO.0 2 i� , .- Licensee: 6aMtZW) MfLVINSignature �J� LIC.NO.:215: • (If applicable,ent7"acme a in the 1 cense nw ber line) Bus.Tel.No.... Address: " L- 'IL.JDN fUU Int I i ed a a it b b Alt.Tel.No. *Per M.O.L.c.147,s.57-61,security wor requires Department of Public Safety"S"License: Lk.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)❑owner ❑owner's agent Owner/Agent I PERMIT FEE:$ Signature Telephone No. • ‘1") lb4w .. • S • • • • _w The Commonwealth ofMassachusetts • 1 -5'MY=tt Department oflndustrialAccidents -"_ y • I Congress Street,Suite 100 • -`IBoston,MA 02114-2017 '`�` ' www.rirussgov/dia ' -"Workers'tompensation Insurance Affidavit:geherdl Businesses,.,• r 1 N ;.e ':• TO BE FILED WITH THE PERMITTINGAITIHOFITY.l. Ai I licant Information . Please Print Le!ibi • 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.El am a employer with Business Type(required): . or part-t me).+ tL_enipioyees(full an. 5. 0 Retail.`. '• . • • 2.0 I am a sole proprietor or partnership and have no 6. ORestauranUBar/Eat ng Establishment employees working forme in any capacity. 7. 0 Office and/or Sales(incl.real estate,auto,etc.) • 3.0 [No workers'comp.insurance required] 8. 0 Non-profit We are a corporation and its officers have exercised 9. 0 Entertainment • their right of exemption per o.152,§1(4),and we have 10,0 Manufacturing 4.0 no employees.[No workers'comp.insurance required?* We are anon-profit organization,staffed by volunteers, 11. ❑Health Care • withno 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 infoimation. **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. ' 1amen employer thefts providing workers'compensation insurance formyemployees. 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 (yyqq Eirationate: Attach a copy of the workers'compensation policy declaration page(showinggth policy nu ber01/20and expiration date). Failure to secure coverage as red under Section of MOL c. of a fine up to$1,500.00 and/or one-year imprisonment as5well as civil p n5alties ican n the form of a STOP WORK ORad to the imposition of criminal DER aanenaltind 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 i Investigations of the DIA for insurance coverage verification t'f . • Ido hereby cera) the,a' and,•naltles o perjury that the Information provided above b true and correct. • SI:nature: x. t-ti a.°ehl••••• Date: 51 !] 'hone#:508-394.7776 Official use only. Do not write to this area,to be completed by city or town official City or Town: . Issuing Authority(circle one): • Permtt/License# 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board S.Selectmen's Office 6.Other ContactPerson: Phone it: www.masa.gov/dia •