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Home My WebLink AboutBLDE-19-001727 • a Commonwealth of Official Use Only ' Massachusetts Permit No. BLDE-19-001727 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 IN INK OR TYPE ALL INFORMATION) Date:9/21/2018 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) 39 MATTAKESE RD Owner or Tenant HOWARD JEFFREY R TR Telephone No. Owner's Address THE JR&L F HOWARD REV TRUST,90 MIDDLESEX ST,CAMBRIDGE,MA 02140-2525 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: Provide receptacle for fireplace blower. 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 ❑ ln- 1:1No.of Emergency Lighting grnd. grnd. Batten Units • No.of Receptacle Outlets 1 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/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 Watery 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 t (( 1((6 egg r Comnwnweagof rr/aeeac�xueslid Official Use Onl iq-l-( I jr cy� cc77 nn PennitNo, fir'; Theparfinenl o/Tire&races ti Occupancy and Fee Checked ti.„------.;-:, BOARD OF FIRE PREVENTION REGULATIONS (Rev 1/07j peaveblankr)_____ • 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: 5��r /9 ??4t City or Town of: To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) - ,W,., 4, ,, - A-". Wes')' • Owner or Tenant .,1, oa Z Telephone No.•f'pt=7. -CJ 'd Owner's Address -tn. Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose°MBunding ' Utility AuthorizationNo. 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: . 4L il!de / i n.o." Coin'teflon o the ollowin:table ma bewaived b the Ins actor o Wires. No.of Recessed Luminaires No.of Ceil:Sus .(Paddle)Fans .o.of oto p Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above in No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS iNo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices Heat Pum Number Tons No.of Self-Contained No.of Waste Disposers p I•-•--- I �'" ''— Detection/Alertin Devices — Totals: Municipal No.of Dishwashers Space/Area Heating KW Local 0 Connection ❑ Other Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water T{w No.of No.of Data wiring: Heaters Signs Ballasts No.of Devices drEgaivalent Telecommunications Wiring: No.Hydromassag Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail ifdesire4 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 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRMNA X UJ 105L014) •t. '-'V . b- ep r to SO • ' LIC.NO.: Licensee: r- aF,%Zf) /14 Vino Signature j ' • EEC.NO.:,2__ 7 ' (Ijapplfenble,er+br"exem.t"ln the license nm bei line.) Bus.Tel.No.•e tit Address: " L' 's JON itcte 5016 I / OIL r- 0 A'." Alt.Tel.No. -- *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 tequired by law. By my signature below,I hereby waive this requirement I am the(check one 0 owner 0 owner's a ent Owner/Agent PERMIT FEE:$ Signature Telephone No. Sv /Gyp . 6 / t ...N • A II The Commonwealth of Massachusetts _V Department of Industrial Accidents =Mice." 1 Congress Street,Suite 100 ' �s. Boston,MA 02114-2017 "' www,massgov/die Workers'Compensation Insurance Affidavit:General Businesses.. • TORE FILED WyITUTHE PERMJn GAUTHORITY, Ar rlicantInformation Please Print Le libl • Business/Organization Name:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02884. Phone#:808394-7778 Are you an employer?Check the appropriate box: 1.0I am a employer with Business Type(required): or part-time).* employees(full and/ 5. 0 Retal 2.0 Iant asolo proprietor orpartnershi 6. QRestaurant/Bar/Eating Establishment • capaci have no 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any 3.❑ [No workers'comp.insurance required] We aro a corporation and its officers have exercised 8.90 Non-profit • their right of exemption per c.152,§1(4), 1 0 ManEnteufacturing no employees.[No workers'comp.insurance eq have 10.❑Manufacturing 4.0 We are a non-profit organization,staffed by volunteers,lu with no employees. 11. Health Care [No workers'comp,insurance req.] 12.0 Other *Any applicant that ehecks box 11 must also fill out the section below showing their workers'compensation policy!daimatlon. "lithe corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization shoed check box pl. ' I am an employer that Is providingworkers'cornpensation insurance for my employees. Below le 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.Lie#1821A {{yy� Attach a copy of the workers'compensation policy datiExpiration eclaron page(showing the policDnumber0and 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification• Ida hereby corEl :.- the•¢- and renaltles o perjury that the information provided above Is true and correct Sia store• t', L . n !!! 'hone#•508.394.7778 Date r] 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 of Health 2.BuildingDepartmeut 3.City/'I'own Clerk 4.Licensing Board 5.Selectmen's Office 6.Other ContactPerson: phone#: Www.mass.gov/die