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Home My WebLink AboutBLDE-19-002090 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-002090 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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 Inspecto of Wires: By this application the undersigned gives notice of his or her intention to perform the iwork described below Location(Street&Number) 15 JOHN HALLS CARTPATH VI 1t��a� xeCiO/yc-r-r AJ VA/2r Owner or Tenant TEDESCO WILLIAM N Telephone No. Owner's Address C/O LONKART ROBERT, 15 JOHN HALLS CARTPATH,YARMOUTH PORT,MA 02675 Is this permit in conjunction with a building permit? Yes 0 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 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 Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd, grn . 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 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 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 cenify,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 et) ► ( (Gf(8 n/� A� q�� OfficialUse^Only�� l,.ommorturea(tlt o�r//assac�effa Ire= 'r PermitNo. .l" Q �(23 C7 >� eparfinenfo�.,ire serviced ,. ._ • Occupancy and Fee Checked ,,, BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/01 (leaveblanld • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code •C), 27 CMR 12.00 (PLEASE PRINT IN INK ORTYP ALL INFOrEOM Date: City or Town of: a. . ,i QI1 In To the Inrpe for of Wires: 1,1 By this application the undersigned gives notice of his or her intentionto perform the electrical work described below. I v itv !� O2la7S Lb'cation(Street&Number) 15 Jo hA Wed a a- i ' � Telephone No. 5_1911211_71a'� Owner or Tenant Job. f.4 Lon Owner's Address S 1314 F Is this permit in conjunction with a guildingpermit? Yes 0 No Ei, (Check Appropriate Box) Purpose of Building ' ) 1)JZ(It in Utility Authorization No. Existing Service^ Amps ' / Volts Overhead❑ Undgrd❑ No.of Meters ____ New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters _- Numbbr of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 60 c 6 V h aC Q I . • Com.letion o the ollowin:table in, be waived!) the ITota r o Wires. No.of Recessed Luminaires No.of Ceil,Sus . r.o p (Paddle))Fans Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators ICVA Above in .of Luminaires Swimming Pool >rnd. ❑ grnd. ❑ Batt.'Noof Emergency Ligh n — ery Units 1N No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones r VNo.of Detection an No.of Switches No.of Gas Burners Initiating Devices • No.of Ranges No.of Air Cond. r Total No.of Alerting Devices Tons a4 No.of Waste Disposers -Heat Pump Number 1 ions I�(W No.Detecf tion/Alerting Totals: I Detection/Alerting Devices Municipal Other No.of Dishwashers Space/Area Heating KW Local Lin Municipal ❑ No.of Dryers HeatingAppliances KW Sicurity 5 stems:* ry pPNo.of Devices or Equivalent No.of Water No.of No.of Data Wiring: 00 Heaters KW Signs Ballasts No.of Devices orEgnivale _ No.Hydromassage Bathtubs No.of Motors Total IIP Telecommunications Wiring. No.of Devices or Equivalent OTHER: SO Attach additional detail ifdesired 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 /� BOND 0 OTHER 0 (Specify:) • I cert,under the pains and penalties of perjury,that the information on this application is true and complete. P • LIC.NO.: 'j4 FIRM NA : � to NSLdW .L Is � r e1' r t51 t,P ' _ -- A Licensee: f n M tiV(y Signature ../i -1 LIC.NO.o�I S/�� ' (Ifappilmb/e,ent "exern.t"lnthelieensenw berline.) Bus.Tel.No.�S08 nt Address: - - 4 L14N6 itaa vu, : t ,u ti p1119 0 b_ AR.Tel.No.:—_____ *Per M.O.L.o.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 ant the(check one)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE:$ Signature Telephone No. L.�, '7 . 61) lad • • • The Commonwealth 4 =ate ofMassachusefts t i=(t Department ofIndusfrialAccidents i;t'( 1 Congress Street,Suite 100 1 if Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:GeneralBusinesses.. TO BE FILED WITH THE PERM TTINGAUTHORITY. A s'leant Information Please Print Le!ibl • Business/Organization Name:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. phone#:506394 7778 Are you an employer?Check the appropriate box: 1.❑✓ I am a employer with Business Type(required): or part-time).* employees(full and/ 5• 0Retail • 2.0 1 am a sole proprietor or partnership and have no 6. 0 Restaurant/Bar/Eating Establishment 7• El and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 3.❑ [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 l0.❑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 infoimaon. **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#1. ' I am an employer that's 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 Expiratioate:011/20N Attach a copy of the workers'compensation policy declaration page(showing the pole Dnu ber and expiration date). Failure to secure coverage as required under Section 25A of MOL 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. Idahereby cue s the'ayhyand renaltteso perjury that the information provided above is true and correct Date: / 'h, a#.508-394-777 8 • Official use only. Do not write In this area,to be con'pieted by city or town official City or Town: IssuingPermit/Llcense# . Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town-Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia