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Home My WebLink AboutBLDE-19-001761 (IV Official Use Only 11 Commonwealth of �E `.rttill Massachusetts Permit No. BLDE•19-001761 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:9/24/2018 City or Town of: YARMOUTH To the Inspector of Wires: ^•'1e_ 621 r n � By this application the undersigned gives no ice o is or her in en ion o per orm e e rca wodc d cri d below. ( teq Location(Street&Number) 41 LOWER BROOK RD :I!MS Owner or Tenant CAVANAUGH KATHERINE M TRS Telephone No. Owner's Address MCGOWAN WILLIAM M,49 PURCELL DR,ALAMEDA, CA 94502-6563 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: Install generator. 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 1 KVA 8 No.of Luminaires Swimming Pool Above ❑ In- CINo.of Emergency Lighting rnd. 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 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 ,Siena 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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$75.00 -.---- 21•Itt t , i/c/s «(tq(f8 /� nn'' qq� II �f�cial Use Only • �/ Commonwealth o/rr/ao achueeit� 9}1 p `lt-y/• ft Permit No. lel 1, 11_ $ -`� c � cc77 n(� k rim- 2 .Uepariment o/Jiro Jervicn tit Ur d' Occupancy and Fee Checked *p 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 n(ME ),527 12.00 (PLEASE PRINT IN INK OR�2TPEALL INF /TII01� Date: []moi �cZ I (5?/ City or Town of: V(1f(1�Ot 7-) ( ,l(1L>` ) To the Inspector of Wires: By this application the undersign d gives notice of his or her intention ttdd perform the entrical work described below. Location(Street&Number) G e m •s r a 1l,, � TelephoneNdcQg-�g's7? (�• Owner or Tenant �� Il!■ � � Owuer's Address S Am F Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) OQPurpose ot$uilding_T]�P I I I (l(' Utility Utility AuthorizationNo. Existing Service_ Amps I J Volts Overhead 0 Undgrd 0 No.of Meters — • ONew Service _ Amps 1 Volts Overhead 111Undgrd 0 No.of Meters Number of Feeders and Ampacity �� Location and Nature of Proposed Electrical Work: n K It ) (-f e r e I C /"(' . 0 ry„a .' • Completion of the followingtable may be waived by the Inspector of Wires. • No.of Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA • • No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.ofEmergency Ltgn m No.of Luminaires Swimming Pool , nd. : ml. 0 Batter 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 ndInitiating Devices No.of Ranges No.of Air Cond. Totalas No.of Alerting Devices No.of WasteDia osers Heat Pump Number ions I{W No.of Self-Contained _ P Totals: Detection/AlDevices unicipal 0Other No.of Dishwashers Space/Area Heating KW Local o Connection No.of Dryers HeatingAppliances KW Devices ry PP Security of Devices or Equivalent No�ater No.if— No.of Data Wiring: Heaters KW Si: s Ballasts No.of Devices orE.uivalent e ecommun cations inn No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent L9 OTHER: • Co Attach additional detail ifdesired,or as required by the Inspector of Wires. Do Estimated Value of Electrical Work: (When required by municipal policy.) • i Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. bo 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 1-13 • undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Ell 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: �°r it t .ow PGltrni'cV(n u.- ff�i4� ! HOG . • LIC.NO.: Licensee: (�t FKLO /14 t VW Signature J,L0LIC.NO.:i9I57rI7 • &applicable,ant ir"tem it"In the license na bei line) / Bus.Tel.No: rs. 8 Address: " L' is, IOtU G gat Ott At, O 1At ` 0 b 4 AIL 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 fequired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner 0 owner's agent Owner/Agent I PERMIT FEE:$ SO • ', Signature Telephone No. /- " • 4 .... The Commonwealth of Massachusetts a yet 1 - l= t Department ofIndusfrialAccidents =s111-7 ice p 1 Congress Street,Suite 100 ' _ Boston,M402114-2017 '�• www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses.. TO BE FILED WITH THE PEmarrrING AUTHORITY, A, alieant Information 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: Business Type(required): 1.0 I am a employer with employees(full and/ 5. 0 Retail or part-time).* • • 2.0 I am a sole proprietor or partnership and have no 6. OResta rano ar/Eatmg Establishment 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 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 10,0 Manufacturing 4.0 no employees.[No workers'comp.insurance required]** 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#1 must also fill out the section below showing theirvrorkers'compensation policy h&j/nation. **If the corporate officers have exempted themselves,but the corporation has otheremployees,a workers'com nation policyis organization should check box#1. pe required and such an ' I am an employer that is providing workers'compensation insurance for nay employees. Below is the 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 {Expirationy Attach a copy of the workers'compensation policy declaration page(showing the policy number 0and 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. I do hereby cern nalttes o perjury that the information provided above is true and correct Si: attire: L ,. • Date: . one#:508494-7778 • Official use only. Do not write ha this area,to be completed by city or town official City or Town: Permit/License#Issuin Authority(circle one): • • 1.Board of Health 2.Building Department 3.City/Town-Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia