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Home My WebLink AboutBLDE-19-002543 Commonwealth of Official Use Only `4 " Massachusetts Permit No. BLDE-19-002543 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 PRLVTINLNK OR TYPE ALL INFORMATION) Date:10/29/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. Location(Street&Number) 25 STILES RD Owner or Tenant MCDONOUGH FRANCIS X Telephone No. Owner's Address MCDONOUGH KATHERINE A,25 STILES RD,SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Air Cond.System 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. 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. 1 Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: __.. Detection/Alerting Devices _ -- No. No.of Dishwashers Space/Area Heating KW Local ❑ 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 Slots 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 cetrify,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 Sc1 id&/ie it\ l,oramonwea&o/r//a achuaeffi O��fficci7iallUse O�nfly y f: cy c7 n PermitNo. 19 ^ "' e. 1JaParimen�o/ }iraJewlce! Occupancy and Pee Checked%� e ; it sfi BOARD OF FIRE PREVENTION REGULATIONS [Rev.1107] (leaveblank) — • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code(MBC),527 CMR 12.0_0 (PLEASE PRINT DT INK OR ALL INFORMATION) Date: O �� I QV' City or Town of: To the Inspector of Wires: • By this application the undersignedgrves otip of his orh irate tio,top rmtheelectricalworkkpdeseribedbelow. L'dcatton(Street&Number) as /e I • s, V unoo as ' 4 Owner or Tenant viaL_ I anWifits Telephone No.S�L 5g0 Q6 Owner's Address t: Is this permit in conjunction itIkabuilding permit? Yes ❑ No 3 (Check Appropriate Box) Purpose odBuilding,�w \\ In •'-'/ Utility AuthorizationNo. Existing Service_ Amps Volts Overhead❑ Undgrd 0 No.of Meters New Service _ Amps / Volts Overhead 0 Undgrd❑ No.of Meters Numbbr of Feeders and Ampacity MI ( 0 Lo cation and Nature of Proposed Electrical Work: k S S Com deltas;o the ollawin:table ma be waived 6 the Isaactor t ro Wires. No.of Recessed Luminaires No.of CeiLSu (Paddle)Fans o.of sp• . Transformers KVA No.of Luminaire Outlets No.of Hot Tubsp Generators KVA. `0.0 mer:ency Mg,• No.of Luminaires SwimmingPool grnd e ❑ i r- nd BatteryUnits 0 No.of Receptacle Outlets. No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and • No.of Switches No.of Gas Burners Initiatint:Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices Ilea Number_Tons KW No.of SaContained No.ofWaste Disposers Totals: — Dtection/AleMunicipal Devices No.of Dishwashers Space/Area Heating KW Local❑Connection LA Other Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent WO".-ca-Water No.of No.of Data Wiring: Heaters RWSigns Ballasts No.of Devices dr Equivalent • No.Hydromassage Bathtubs No.of Motors Total HP TatecNing: o of Devices or Emmunications quivalent OTHER: 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 withMEC 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 certify,under the pains and penalties ofper]ury,that the information on(lits application is true and complete p g ' LIC.NO.: j (� .�- F$tMNAME:_�� tt)lIt1SCdW PG[tM3[oLo 4' tl�'><i' cif SO, ll� • — Ff Cr 0 —1— �r � . LIC.NO.:09IS�q ( _ Licensee: IQQ /14 twig) Signature��// l / �/� (Ifapplicable,ent 'exemd"Inthe license is ber line) Y Ens.Tel.No.:98:: — ora CP O Address: L '! la Ai t Salt 1♦ ;de a p • thief 0 b Alt.Tel.No.:._-- v *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 am the(check one 0 owner ❑owner's a ent. Owner/Agent PERMIT FEE:$ Signature Telephone No. • 61) �� if .. . r • • =�_ The C minonweaith o • fMassacitusetts . t _t=ey 1r• De�� nt bflndustriaiAccidenis - �'.% f Congress Street,Suite 100 • , Boston,.B1,4 02114-2017 , , • �lor• kerst ww•w.massgovldia • ' Co npensation Insurance Affidavit:General Businesses.. A.illeant information TO BE FILED Business/OrganizationName:E.F.WINSLo Please Print Le 'bl W PLUMBING&HEATING CO.,INC • Address;8 REARDON CIRCLE City/State/Zip;SOUTH YARMOUTH,MA 02664. Phone#:508394-7778 Are you an employer?Check the 1. I s a employer with10___appropriate _emp box: Business : Type(required) or part-time)♦ "�— employees(full and/ 5, ❑Retail • 2.0 Iamasolo proprietarorpartnership and have no 6 QRestaurant/Bar/Eat ngEstahlshment 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 3.❑ [No workers'comp.insurance required We are a corporation and its officers have exercised 8. Non-profit their right of exemption per c.152,§1(4),and9. 0 Entertainment we ng no employees.[No workers'comp.insurance required? loll Manufacare 4.0 We are anon-profit organization,staffed byvolunteers, II.ElHealth Care with no employees.[No workers'comp.insurance r I�-tt 'Anyapplicant that checks box#1 must also fill out section the �'� 12'u Other *Anyecoiporath officers have exempted ars fill below showingtherworkers'cora organizationshodd check box#1. ea.buttbeeoryoranonhas pensadocompe compensation °theremPloYers,aworkers'compensation policy is required end such an Iamanemployer that xx#rovtdIngworkers'compens onInsurmceforntyemployees. Below is The policyalit ARROW MUTUAL INS URANCE COMPANY Insurance Company Name: Insurer's Address:23 COMMONWEALTH AVE City/State/Zip; CHESTNUT HILL,MA 02467 • Policy#or Self-ins.Lie.#1821A • Attach a copy of the workers'compensation policy declaration page(showing the policy numb er0and expiration date). Expiration Date: 1 Failure to secure coverage as required under Section 25A of MGL G.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 g coverage verification. rdoIdoherebyeerti :- • " enalilese perjaryrhortkeinformattonprovtdedabovelstrueandcorrecl. ill re: / —Awsra a e;;508.394.7776 Date: - '7 Official use only. Do not writeIn l/rlsarea,to be completed by city or town official; • • City or Town: Issuing Authority(ctrcleane): Permit/License# 1.BoardofHealth 2.Building ` 6.Other g De parbaent 3.Ctty/Toy Clerk 4.LicensingEoard S.Selectmen's Office Contact Person: Phone#: • wwv+.messgov/dia