The URL can be used to link to this page

Home My WebLink AboutBLDE-19-001972 • I Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-001972 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked f Rev.1/07j 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:10/3/2018 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 belo Location(Street&Number) 300 BUCK ISLAND RD UNIT 3P Upier 3— • Owner or Tenant YOGEL MARTIN H Telephone No. Owner's Address 5367 LANDON CIR,BOYNTON BEACH,FL 33437 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 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 HVAC Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ce16-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. Batten 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. 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.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 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 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 1 (/)/10 } Commanwea o adeacItoeth /0 a1 e Only i ,,,, --a',4 pgg�� cc7y c7 `/(7 Permit No. =nts; Te arinwnt o/,lira...cervical eV"� Occupancy and Fee Checked � a°f BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 r 12.00 (PLEASE PRINT IN INK ORT EALLINFORMATI ) Date: ' 27 i8 City or Town of: //�n/�j'Ji(OrtS To the Inspector of Wires: By this application the undersign d gives • ice of his or her intentio o perform the electrical work described b low. . Location(Street&Number) Ot' ,osCLQ $1470,0 114 tf`3,4 • J Owner or Tenant /nru) o(o$ TelephneNNo Owner's Address Z CC,UGL6 ' i S Oi 1 h`pee Is this permit in conjunction with a building permit? Yes El No [✓ (Check Appropriate Box) Purpose onuilding ' acoeui/U6o 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 !L. Location and Nature of Proposed Electrical Work: ILtPL.4Gt. Fu2Abiele-e eat- . 0 ... . f _ L . Completion of thefoilowingtablemaybewaivedb thefTotaoro Wires. • No.of Recessed Luminaires No.ofCeil:Sus .(Paddle)Fans Tran p Transformers FNA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- .afEmergency Lightng No.of Luminaires Swimming Pool and ❑ gra Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of tion and No.of Switches No.of Gas Burners No. ImitiatingDevices CN.- No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste DisRest lump Number Tons KW No.of Se tl�ontained Totals: Detection/Alerting Devices in% Municipal Other V) No.of Dishwashers Space/Area Heating ICW Local❑ Connection 0 No.of Dryers KW security Systems:* ^ Heating A y g liances PPNo.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWo. Ballasts No.of Devices or Equivalent Telecommunications Wiring No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: ( Attach additional detail if desired,or as required by the Inspector of Wires. Q Estimated Value of Electrical Work: (When required by municipal policy.) 6% . 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 El BOND 0 OTHER 0 (Specify:) ' I cartljy,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: :sr ft) NStQW eta '--J to d" fl' di f SO ' LIC.NO.: Licensee:14041M M2LV(Iv Signature LIC.NO.:o�/S�`/' ' (ifapplicable,ent "ex m 4"in the license n ber tine.) ,' Bus. Tel.No.•'Kd� Address: " L`1/LJON 6 feat `,vtt u at V i tb 14 A ` 0 k Alt.Tel.No.:____--- k *Per M.O.L.c.147,s.57-61,security wor requires Department of Public Safety"S"License: Lic.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 cut. Owner/Agent • PERMIT FEE:$ Signature Telephone No. • -C l • A t _=te f The Commonwealth ofMassachusetfs _ � gg Department ofluduslria1Accidetrfs ii)-`�Oy 1 Congress Street,Suite 100 ' J Boston,MA 02114-2017 • , Workers' www.massgov/die Compensation Insurance Affidavit:Generall3nsinesses.. TO BE FILET,WITH THE PERMITTING AUTHORITY. A. r]icantInformation 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#:508-394-7778 Are you an employer?Check the appropriate box: 1.12] I am a employer with Business Type(required): . orpart-time).+ employees(full and/ 5• 0 Retail 2.0 Iamasole proprietor orpartnersh6. [RestaurantBar/Eating Establishment • ' partnership have no 7 Offirs and/or Sales(incl.real estate,auto,etc.) employees working for me in any c 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.❑ no employees.[No workers'comp.insurance required?* 10'0 Manufacturing We are a non-profit organization staffed by11.❑Health Care employees.[No workers'comp.insurance volunteers, with no "Arty applicant no checks P e req.] 12.0 Other box Sl must also fill out the section below showing their workers'compensation policy infoimatiom **If the corporate officers have exempted themselves,but the w organization should check box Hl. corporation has otheremployees,aworkers'compensation policy is required and such an ranemployer that isproviding workers'compensation Insurance forntyemployees. Below is Me 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'compensat on policy declaration page(showing the policy number01/20and expiration 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ' enalfies oper�uryThat the information provided above is true and correct Si:nauue: 7 wn a,......a,...... Date: / • rt 'hone#:508-394-7778 Official use only. Do not write in this area,to be completed by city or town official • City or Town: • IssuingAuthorl ( Permit/License# circle one): I.Board ofHealth 2.$uildm D • 6.Other ge partment 3,City/Town Clerk 4.Licensing Board 5.Selectmen's Office Contact Person: Phone#: wwwmass.gov/die