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Home My WebLink AboutE-19-2546 ack Commonwealth ofOfficial Use Onlya t Massachusetts - Permit No. BLDE-19-002546 • 4 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:10/29/2018 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) 292 NORTH DENNIS RD ' Owner or Tenant ROCKEFELLER BARBARA M TR Telephone No. Owner's Address BMR REAL ESTATE NOMINEE TRUST,292 NORTH DENNIS RD,YARMOUTH PORT,MA 02675-2166 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: Heat pump system. 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 0 In- 0 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 KW No.of Self-Contained Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ 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 ❑ 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 .d� n ng qq� I Official Use Only , e �-\ • l,.ommonwea&L o/tt/aedachudeifJ /—Jl � @i c� c7 n YermitNo. =M .Department o/. ire Serviced 'IVY g. Occupancy and Fee Checked \Z„,4 BOARD OF FIRE PREVENTION REGULATIONS [Rev 1107] geavebiank) — • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to beperformed in accordance withtheMassachusetts Electrical Code 3y7)CMR12.00 (PLEASE PRINT Thi INK OR E ALL INFORMATION) D ate: I City or Town of: fivl k To the Inspector of Wires: • • By this application the undersignedvesnoticeofhis orher intention toverforppmt.a lee:ricalwork described below. Lb'dation(Street&Number) , 9 a , `I e A l K 4 / 4, // lobo 7 6G Owner or Tenant 9( t l' t 11'0 t' / T/elephoneNO,_5_01,31Y— Owner'sAddress .AW1 �/ Is this permit in conjunction with a building permit? Yes ❑ No L' (Check Appropriate Box) Purpose ofTuilding 'htiueIli n�j Utility Authorization No. Existing ^ Amps ' / Volts Overhead❑ Undgrd 0 No.of Meters New Service _ Amps / Volts Overhead Undgrd❑ No.of Meters Number of Feeders and Ampacity G /Oh Location and Nature of Proposed Electrical Work: a I� 1 M ( 4 5 Completion ofthe followingtabo/eona bewai'edb thele- catoro Wires. No.of Recessed Luminaires No.of Cell.Susp.(Paddle)Fans Transformers 1tVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA ' Above In- No.of Emergency LighC No.of Luminaires Swimming Pool end. ❑ grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS Sing of Zones No.of Detection and • No•of Switches No.of Gas Burners g 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 ry Detection/AaDevices Municipal ❑Other No.of Dishwashers Space/Area Heating KW Local 0 Connectlon security Systems:: No.of Dryers Heating Appliances ICW No.ofDevicesorEquivalent No,of Water No.of No.of Data Wiring: HeatersKSigns Ballasts No.of Devices or Equivalent Telecommunications inn ?o.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent • OTHER: • Attach additional detail IIfdesired 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 ❑ OTHER 0 (Specify:) —S� • Thera under the pains andpenaltles of perjury,that the information on this application Is true and complete. OQ��t� FIRM NAME: ✓ CO1 L_. Pt. 3iVivlo d" 4e7 (Az . ' LTC.NO.: Cr LTC.NO.:oO/S n_ ��}.= Licensee:�t e /n12UIIN Signature v fif%� ` Bus.Tel.No.: - (Ifapplicable,eat 'ex-nt.t"tnthe licensenumber line.) N c:r3 ED Address: L !'t /0N Gt e 5vt�tf4 tii41aro(tttl,AW& AIhTel.No,:--- ' *Per M.O.L.c.147,s.57-61,security wor. requires Department of Public Safety"S"License: Lio.No. Z '� 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 ant the(check one)0 owner 0 owner's ent. Owner/Agent PERMIT FEE:$ Signature Telephone No. • 51 • • A The Commonwealth o �i� 1, fMlAcei encs s � .Department oflndustrialAccidents i, eel- i X Congress gressSlreet,SuiteX00 �`� Boston,MA 02XX4--2017 • Workers' www,massgov/dia Compensation Insurance Affidavit:GeneralBusinessen. A.alicantInformafion TO BERG WITH�PERMITTING AUTHORITY. • Business/Organization Name:E. F.WINSLow PLUMBING&HEATING CO.,INC please print Le'ibl Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. Phone#:508947776 Are you an employer?Check the appropriate box: I. I am a employer with Business Type(required): or part-time).* '`employees(full and/ 5. 0Retal 2.0 I sin a solo proprietor or Partnership and have 6. ['Restaurant/Bar/Eating inti. eEstablishmentestate employees working for me in any capacity, 7. 0 Office and/or Sales(incl,real estate auto, 3.0 [No workers'comp.insurance required] etc.) We are a corporation and its officers have exercised S. 0 Non-profitra • their right of exemption per o.152,§1(4),and9• Li fMnutainment no employees,[No workers'comp. we have 11.0 manufacturing ng • 4.0 We are a non-proEt organization st�azn�required? with no employees. 'staffed by insurance req.] 11.0 Health Care [No workers comp, nsurancareq.] 12.0 Other MYapplicant that checks box#1 must also fill out the sec aIfthawryonteofficers kshave exemptedso Ell out but sctionb owshowin - orgaoirstionshouldcheckbox#1. o eremployee.aworkers'c compensation policy infoimation. corporation other employees.a workers'compensation policy is required and such an • amanemployer Mails providing workers'compensation Insurance formyemployees. Below is Me policy Information, InsuranceeCompany Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 •Policy#or Self-ins,Lia.#1821A Attach a copy of the workers'compensation alit 01/01/20/117 Expiration Data: Failure to secure coverage as required under Section 25A ofMGL .152 can lead to the impositihof ncriminal penalties oft 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 co Investigations of the DIA for insurance coverage Py of this statement may be forwarded to the Office of • I do hereby cern' • /J verifcation. goalieso perjurytl:atthe tnfarmaltonprovtdedabove ls6ueandcorrect i'ystore: Date: 7hone: 508.394.7778 Oficial • use only. Do not write ht this area,to be completed by city or town official City or Town: Issuing Authori[y(circleane): Permit/License# 1.Board ofltealth 2.Building Department 3,City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wa^v.mssgoe/dia •