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Home My WebLink AboutBLDE-19-002672 Commonwealth of Official Use Only LIU Massachusetts Permit No. BLDE-19-002672 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date:11/2/2018 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) 11 NAUSET LN Owner or Tenant NIGRO NICHOLAS J Telephone No. Owner's Address NIGRO AGNES M,3214 TIBBETT AVE, BRONX, NY 10463-3801 Is this permit in conjunction with a building permit? Yes ❑ 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: 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. grnd. 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/Alertine 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 ❑, (Specify:) !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:$75.00 a I nn„ r Official Only n / a • ommonwea o adaac udeifd /E��, 1, `-• t 9. ccyy Ai cc77 �a Permit No, ra .ueparimenl'oi.7ire Serviced • cf W Occupancy and Fee Checked r4, £M� BOARD OF FIRE PREVENTION REGULATIONS [Rev llO7j (leaveblank) — • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with thevassathusetls Eleefrical Code(MEC) 527 CMR 12.00g (PLEASEPRINTINMI(OR ALLINFORMATION) Date: ('�s City or Town of: Pa To the Inspector of Wires: By this application the undersigned giv-a noticeo his or lir intenqoy to perform the electrical work described below. • Meilen(Street&Number) i t I/2 a ve 4- Monet/HI Io. . a9 6a Owner or Tenant MO/YIDS Nt01iO TeIephoaeNd.� Owner's Address cAiv �I � Is this permit inconjunc'onwit gbuilding permit7E Yes 0 No (CneckAppropriateBox) Purposeottuilding ' W2I\(rki Utility AuthorizationNo. Existing Service Amps ' / Volts Overhead 0 Undgrd 0 No.of Meters NewService _ Amps 1 Volts Overhead 0 Undgrd❑ No.of Meters •__ Numbbr•of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 6, g ( S AvAlr A A Com'teflon o the ollowin:tablle=nifq bewaNed6 the Ins ccttoro Wires. • To al No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Transformers No.of Luminaire Outlets No.of Hot Tubs Generators KVA ,ov,a `0.0' mer:ency g' ,g No.of Luminaires • SwlmmingPool end ❑ grnd. u Battery Units - - No.of Receptacle Outlets No.of Oil Burners 'FIRE ALARMS No.of Zones o.o etectron an • No.of Switches No.of Gas Burners Initiating Devices • Nd.of Ranges No.of Air Cowl Total No.of Alerting Devices Tons Heat Pum Number Tons NO.ofSelfContained No.ofWasteD3sposers Totals: Detectien/Alertin Devices Loca ❑Municipal No.of Dishwashers Space/Area Heating KW Connection u Other Municipal Systems:* No.of Dryers HeatingAppliances 11W No.of Devices or Equivalent No.of Water Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent • Telecommunications Wiring: No.Hydromassage)iathtuhs No.of Motors Total FIE' No.of Devices or Equivalent OTHER: Attach additional detaillfdesired or as required by the Inspector of Wires. Estimated Value ofElectrical Work: (When required by municipal policy.) - Work to Start: Inspections to be requested in accordance withlviECRuleID,anduponcompletion. 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. • 0 CHECK ONE: INSURANCE Ef BOND 0 OTHER 0 (Specify:) • I cert,under the pains and penalties of perjury,that the in ormatlon on this application is true and complete. � ? L� • LIC.NO,: `�- � � FIRM NAME: ,_� trJ NSCpt,} •G[Lt!/I' U(o �- � ' s � '_• — �/ ,{ Licensee:1 C&f/Can- �V(pl Signature J 'I � LIC.NO.Q!. l� r • Cfapplicable,ent "ex mit"Inthe license n berline.) 4 Bus.Tel.No.. e8- • �� - r/-' lot) G ffaat 5att s.! a ,C9 O 6 Alt.Tel.No. Q Address: U *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 ent. Owner/A ent • Signature TelephoneNo. — PERMIT FEE. . 4 � 7 • • IP•_ The moron o k� 1 1Ie ailment wealth fMassacliusetts S lit: P finent ofIndusfr1a14ccIdenfs =• - 1 Congress Street,Suite 100 • „,,`,t•-• Boston,PM02114 2017 Workers' www,massgov/dia CompensationlnsuranceAffrdavit:General$usinesses.. Ae.licantinformation TO BE MED p/pTILPE GADTHORITY. Business/Organization N Please Print Le.ibl arae:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE • City/State/Zip:SOUTH YARMOUTH,MA 02664. Are you an employer?Check the a Phone#:60894 7778 Are I an employerr? ith Cheek the appropriate box: Business Type(required): or part-time).* "�employees(full and/ 5. 0Retail 6. ORestauraarmatngBstablshment • 2.0 Iemasolaproprietororpartnersfipandhaveno employees working for me in any capacity, • [No workers'comp. nce 7. 0 Office and/or Sales(Si.real estate,auto,etc.) 3.0 We are a corporation and its haveofficers8. 0 Non-profit exercised their right of exemption per0.152,§I(4) and we have 9. Om,anu Entertainment no employees,[No workers'comp,insurance required)* 10.n 4.0 We are a non-profit staffedorganization �J Manufaohumg • with no employees. by volunteers, 11.0 Health Care Any applicant that checks [No workers'came,insurance req.] 12.[]Other • • n apc ortthatc boxmust adsoflll out the section below showing their workers'compensationpolicy W ¢as have n. *If conshould orateocheckhaveex es,but the corporation has other em to pe auoimolicy employees, policy is required end suchen am an employer That Is providing workers compensation snsuranceformyemployees. Solon,lsMepolicyfnformadorr, 'sumo Company Name.ARROW MUTUAL INSURANCE surer'sAddress:23 COMMONWEALTH AVE ty/State/Zip; CHESTNUT HILL,MA 02467 • Hey#or Self-ins.Lin#1821A Expiration Date: r9 tach a copy of the workers'compensation policy declaration page(showing the policy numberandexpiration date). lure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a 3 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 tpto$250,00aday against the violator. Be advised estigationsofthe DIA for insurance covera ga verification, taC0py0fthisstatementmaybeforwardedtothe0fficeof __ aril'hereby tame: na• lttes o perjury fiat the fnformation provided above is Prue and correcd .own aye.. e.•508-394-7778 Date: . '7 - I Okla!use only. Do not wile in this area to be completed by city or town official I ty or Town: • n ngAathar(ty(circle0ne); Permit/Llcense# Board of Health 2.Building De )then parhnent 3.City/Town Clerk 4.LlcensingBoard 5.Selectmen's Office rtactPerson• • Phone#: • Www.msssgov/dis .