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Home My WebLink AboutBLDE-19-002047 f Co Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002047 • 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 ININK OR TYPE ALL INFORMATION) Date:10/5/2018 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) 78 CROWES PURCHASE Owner or Tenant KANE JOHN EUGENE(LIFE EST) Telephone No. Owner's Address KANE THERESA MARY(LIFE EST),28 RIDGECREST CIR,WESTFIELD, MA 01085 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 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 Above 0 In- 1:1No.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 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/Alertine 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 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 ❑ 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 Qfapplicable,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 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:$50.00 8 (O/ta be d� �M//�� // oriel Use Only Cones wnwsdih o//r/addachudett4 pp=VI—1 c7 n PermitNo. 9 ar- r Thepar&nant o/.-tiro Serviced S Occupancy and Fee Checked rp iF BOARD OF FIRE PREVENTION REGULATIONS [Rev.11071 (leave blank) ti.1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC) 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: 10 I2�1 City or Town of: yarn/p(�({n To the Inspector of Wires: By this application the undersigngives notice of his or her intention to perform the electrical work described below. • LWation(Street&Number) ,r, 1'OWeS cot e , g.a es ` / Y - Owner or'Tenant...ThQ(/.eSet &nt Telephone No.la,ca2.3.01 b Owner's Address . . !< 'I' En' I,02- 1-■ 1 t II P40 i Di 5 Is this permit in conjunction with building permit? Yes [11 No No (Check Appropriate Box) Purposeof$uilding `- w.e p1%V\ Utility Authorization No. Existing Service Amps ' / Volts Overhead❑ Undgrd❑ No.of Meters __ 1'tew Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters IV Number of Feeders and Ampacity 1 = Location and Nature of Proposed Electrical Work: • : 0 al r - 1€• • Completion of the following table may be waived by the Inspector of Wires. No.of Total No• .of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators TVA No.of Luminaires SwlmmingPool A d e ❑ I - ❑ Batts Emergyency Light nh U" No.of Receptacle Outlets No.of Oil Burners F1RE ALARMS No.of Zones \..— '/� No.of Detection and No.of Switches No.of Gas Burners Initiating Devices .= No.of Ranges No.of Air Cond. Tone No.of Alerting Devices Disposers eat ump Number.,Tans E,W, _ No.' of Self-Contained No.of Waste Dis P Totals: Detection/Alerting Devices Other No.of Dishwashers Space/Area Heating KW Local❑ ConnecMunicipa tionl 0 _ No.of Dryers RentingAppliances KW Security Noof Systems:* PP No.of Devices or Equivalent No.of Water No. No.of Data Wiring: M Heaters KWSly s Ballasts No.of Devices or E•uivalent CSC No.Hydromassage Bathtubs Noe ecommunications himg.of Motors Total IIP No.of Devices or Equivalent 60 OTHER: -* Attach additional detail if desired,or as required by the Inspector of Wires. CSOEstimated 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 mi BOND ❑ OTHER 0 (Specify:) • I eery,under the pains and penalties of perjury,that the Information on this application is true and complete. 49 • LIC.NO.: FIRM NA �P� [t) NSCdW • 3 ,1J(9 e" SP r I" ' LIC.NO.:r�` I 5777/4Licensee: ICFI-4(2.0 M 2Lvlro Signature ,dr� • (/f applicable,em' "exem.t"in the license nunber line) I Bus.Tel.No.SOS 2 lig Address: - L.` ' /OP (CLIC `Jolt Jae U•a A 0 1, Alt.Tel.No.: *Per M.G.L.c.147,s.57-61,security wor requires Department of Public Safety"S"License: Lie.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:5 I tN� Signature Telephone No. I U t • The Commonwealth of Massachusetts =TIM gt .Department of Industrial Accidents 101= 1 r , e• Congress ess Street Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses.. TO BE FILED WITH THE PERM1TTINGAUTHOHITY. • A. s licant information Please Print Le t 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: 1.El I am a employer wiUr -7^ OBusinessType(required): or part-time).* • r sem_employees(full and/ 5. ❑Reta l 2.0 I am a sole proprietor or partnership and have no 6. ['Resta1antBaz/Eat ng Establ shment • • employees working for me in any capacity. 7. 0Office and/or Sales(ncl,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 c.152,§1(4),and we have IO Q Manufacturing 4.0 no employees.[No workers'comp,insurance required]** We are a non-profit organization,staffed by volunteers, 1-0 Health Cara • 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. **Mho corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policyis required and such an organization shoidd check box#1. pens • ' 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.Lic.#1821A Expirationate:Attach a copy of the workers'compensation policy declaration page(showing the policy nu ber0and0expiration date). Failure to secure coverage as required under Section 25A.of Ma 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ida hereby cerci :• Me.a/1fs and"enclitics o perjury that Me information provided above Is true and correct Si_ ature: •- /[—. L ,..e,. rq /a , Date: I r$_ 1 J t fi 2 '.c e •508-394.7778 Official use only. Do not write In this area,to be completed by city or town official City or Town: Issuing Authori Permit/License# ( 1.Board ofHealih2.Building Department 3.City/Town Clerk 4.LicensingBoard 5.Selectmen's Office 6.Other Contact Person: Phone#: www.masagov/dia