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Home My WebLink AboutBLDE-19-001994 Commonwealth of OfficialUseOnly Ertl Massachusetts Permit No. BLDE-19-001994 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked tRev.l/071 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEA SE PRINT IN INK OR TYPE ALL INFORMATION) Date:10/3/2018 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) 50 ARTHUR LN Owner or Tenant BADER CHARLES Telephone No. Owner's Address BADER EDITH B,50 ARTHUR LN,YARMOUTH PORT,MA 02675-1808 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: Ductless heat pump. • 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- o 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. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons I KW No.of Self-Contained Totals; 1 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 Siens 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 (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 OLD gig, (16 �. cialUseOnly 0 _ -\ Commonwealth o////a1lachude I „, 4t c;� t 1 ��]] \n Permit No. A5 .(JepartmenJ o/. ire&raiace IIN e Occupancy and Pee Checked v =,e BOARD OF FIRE PREVENTION REGULATIONS [Rev 1107] (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code 5 7 C 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) ) Date: / City or Town of: l/e1—(Zg )UTN (eo% To the Inspector of Wires: By this application the undersigned gives notice of his or er intention to perform the electrical work described below. Location(Street&Number) e0 i XT.-kJ-tit 4 E Owner or Tenant C/r'#g,tU-S ,9Q4/L, Telephone No.__________ Owner's Address jn b Is this permit in conjunction with a building permit? Yes 0 No 7 (Check Appropriate Box) Purpose of Building '00f21../Mb-. Utility Authorization No. Existing Service_ Amps ' / Volts Overhead❑ Undgrd❑ No.of Meters __ New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters __ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Geer ' ♦ E- NSR `S r tut*, sysT Com.lettono the of/owtn;table in, be waived b the lnsofcatoro es. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.nf \Q Transformers IC VA `ti No.of Luminaire Outlets No.of Hot Tubs Generators TNA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool , nd• ❑ : rid ❑ Batter_ 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 C No.of Ranges No.of Alt Cond. Totaloy No.of Alerting Devices aNo.of Waste Disposers Heat Pump Number„Tons-,__IS,1r__,_, No.of Self-Contained i— Totals: Detection/i/AAlert Devices lr No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other C?o No.of Dryers Devices No.of Water Heaters KWSi s r No.of Devices Or Eguivalent 'telecommunications Whin% nA No.ilydromassage Bathtubs Devices N OTHER: W Attach additional detail If desired or as required by the Inspector of Wires. ti0 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 [V1 BOND 0 OTHER 0 (Specify:) • I cera)",under tire pains and penalties of perjury,that the Information on this application is true and complete. P ' LIC.NO,: j�a l .._ FIRM NAME: � re.) NStoW •1 "� (9 m- �')• ,, - �P -- Licensee: nlea-'(Ln [VtfW(NSignature f/ LTC.NO.o�1S71 tf Bus.Tel.No.•�o� Address: ent "e is' Fa the license nu bei line) I ' 0 b Alt.Tel.No.:�� Address: �' y !oN ItGi�5va •IL � *Per M.O.L.c.147,s,57-61,security wor requires Department of Public Safety"S"License: Lb.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 0 owner's a nh Owner/Agent pERMIT FEE:$ oili Signature Telephone No. I • 1 a t The Commonwealth of Massachusetts : I Department of Industrial Accidents .1;_ t 1 Congress Street,Suite 100 ' t�_rlirczyz� • Boston,MA 02114-2017 • Workers' www.massgov/dia Compensation Insurance Affidavit:General Businesses.. TO BE MED WITH THE PERMUTING AUTHORITY. AarlicantInformation Please Print Le ibl • Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO.,INC Address:B REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. Phone#:508394-7778 Are you an employer?Check the appropriate box: I.❑J I am a employer with�� Business Type(required): . employees(fulland/ 5. Retail orpartempl).+ • ' 2.0 I am a sole proprietor or patfnershi 6. ORestaurant/Bar/Lating Establishment • capa aTy veno y Q Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any 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 4.0 no employees.[No workers'comp.insurance required? 10.0 Manufacturing* We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees.[No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box in 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#l. an employer that ts providing workers'compensation lnsuranceformyemployees. Below I s the policy Information. Insurance Company Hama:ARROW MUTUAL INSURANCE COMPANY Insurer's Address:23 COMMONWEALTH AVE City/State/Zip; CHESTNUT HILL,MA 02467 • Policy#or Self-ins.Lk.#1821A ate:Attach a copy of the workers'compensation policy declaration page(showingiration pe policynumber0and 0 xpiration 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci :-- the__.a om.ten .y e s o penury that the Informationprovided above is true and correct Sitnature• •H • L —1C. one; 508-394.7778 Date: Official use only. Do not write In this area,to be completed by city or town official • City or Town: Issuing Authority(circle one): Permit/License# • 1.Board ofHealth 2.BuiIdingDepartment 3.City/Tovm Clerk 4.LicensingBoard 5.Selectmen's Office 6.Other ContactYerson: Phone#: wv.w.mass.govidia