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Home My WebLink AboutBLDE-19-002029 • 4.44g012 yea Commonwealth of OfftcialUse Only 8o Massachusetts Permit No. BLDE-19-002029 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked )Rev.l/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 ININK OR TYPE ALL INFORMATION) Date:10/4/2018 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) 10 BOXWOOD CIR VILLAGE Owner or Tenant KING ARTHUR N Telephone No. Owner's Address C/O WOOD EMILY, 10 BOXWOOD CIR,YARMOUTH PORT,MA 02675 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 furnace. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of CeiLSusp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above 0r - ❑ No.of Emergency Lighting grnd. rnd. 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 ❑ 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 Siens Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HPTelecommunications 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 cerlify,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 of 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 oif n(7ft�i�fi Ytb quite rt t Commonwealth oiMassada-ids Off ialUseOnlyg_ 1 — (i Permit No. `,� rile artment o ,}tie Services c 1_ — � P Occupancy and Fee Checked . 'D /� 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 ),52 CMR 12.00 (PLEASEPRINTININK ORTYPE ALL INFORMATIpN) \ Date: {O // ie City or Town of: tiektgl 'urs/ (poX-rJ 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) /Q 430/0...)000 6/ (�bCOS) fa Owner or Tenant C 01 td°OD Telephone No. �_ Owner's Address / Is this permit in conjunction with a building permit? Yes E No v� (Check Appropriate Box) Purposeoffuilding 'gi,J€1.14 0 Utility Authorization No. Existing Service_ Amps ' / Volts Overhead❑ Undgrd❑ No.of Meters __, • New Service _ Amps / Volts Overhead 0 Undgrd❑ No.of Meters __ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: • ( _ �.: di slur-- - Com.letiono the ollowin:table in, be waived 6 the Ins ot lro Wires. o.o No.of Recessed Luminaires No.of CeiLSusp.(Paddle)Fans Transformers KVA • No.of Luminaire Outlets No.of Rot Tubs Generators KVA Above In- No.of Emergency Ugh IC No.of Luminaires Swimming Pool , d• El • nd. ❑ Batte Units `P No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Tony No.of Alerting Devices No.of Waste Disposers Heat Pump Number.,Tons_,,,T No.of Self-Contained ' Detection/Alertin Devices Local❑ Municipal Other No.of Dishwashers Space/Area Heating KW Connection 0 00 ' �ecurityg stems•* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: HeatersKW Signs Ballasts No.of Devices or Eqyuivalent 'telecommunications Wiring: No.IlydromassageBathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: y • 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: 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 C0 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 cuts,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NA :: f CO VSLaW .y/i. (9 41- g ' r •p • • LW.NO.: C Licensee: (C(f/)(LQ 114 al)/g) Signature f 1 /7 LIC.NO.:9/S ' (Ifappltcable,ent rr'exem it"in the license nu ber line.) I Bus .Tel.No. 'S�, —2�� Address: " ;L' 4/ ION /la5Ulb fl ar//[7l6 ti ` 0 6/0 •Alt.Tel.No.:-- -- *Per M.G.L.c.147,s.57-61,security wor requires Department of Public Safety"S"License: Lie.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 a ent. Owner/Agent PERMIT FEE:$ Signature Telephone No. • 60 e4 • aw • • A t �_�_ 1 The Commonwealth ofMassachusetfs j- Department of Industrial Accidents _f ,y 1 Congress Street,Suite 100 €1181 • Boston,M4 02114-2017 "' www.massgov/dia Workers'Compensation Insurance Affidavit:general Dusinesses.. TO BEFII,EDWITH THE PERM TTINGATJTHORITY. Ai slicantInformati0ri 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#:508394-7776 Are you an employer?Check the appropriate box: 1.❑J I am a employer with —q Business Type(required): or part-time).* 1n_employees(full and/ 5• 0 Retail • 2.0 Iamasole proprietor orpartnershi p and yave 6. ORestam'antBar/BatingEstablishment • no 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any [No workers'comp.insurance r quired]rTy 3.0 We are a corporation and its officers have exercised 9. 0 Non-profit • their right of exemption per c.152,§1(4), 9. 0 Entertainment no employees.[No workers'comp.insurance nce we have 10.[]Manufacturing 4.0 We are a non-profit organization, ffed by volunteers,required]++ with no employees, staffed by 11.0 Health Care [No workers'comp.insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselyes organization should check box in. ,but the corporation otheremployees,a workers'compensation policy is required and such an • I am an employer that is providing workers'compensation insurance or m employees. Below is the policy information. Name:ARROW MUTUAL INSURANCE COMPANY Insurance Company Insurer's Address:23 COMMONWEALTH AVE City/Statelzip: CHESTNUT HILL,MA 02467 Policy#or Self-ins.Lic.#1821A • Attach a copy of the workers'compensation policy declaration page(showing the policy numberO1/20/49 and 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. • Ido hereby cerci , :- the.a'and.enalties o perjury that the information provided above is true and correct. Sly'afore' _ 4--.• t "..—. hS Date `] 'hone .•508.394.7778 Official use only. Do not write in this area,to be completed by city or town official • City or Town: Issuing Authorl Permit/License# ( 1.Board ofHealfh2.$uilding Department 3.Ci • 6.Other ty/fown Clerk 4,Licensingl3oard 5.Selectmen's Office Contact Person: Phone#: www.mass.govidia