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Home My WebLink AboutBLDE-19-002930 '41Commonwealth of Official Use Only of t Massachusetts Permit No. BLDE-19-002930 . 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:11/13/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. ' Location(Street&Number) 12 BOXWOOD CIR VILLAGE Owner or Tenant GALLAGHER MARYELLEN Telephone No. Owner's Address 12 BOXWOOD CIR,YARMOUTH PORT,MA 02675-1477 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: 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 0 In- o No.of Emergency Lighting Rind. 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/Alerting Devices No.of Dishwashers 'Space/Area Heating KW Local 0 Municipal ❑' Other: Connection No.of Dryers Heating Appliances KW Security Systems:' No.of Devices or Equivalent No.of Water jY '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 ❑ 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) ❑ owner ❑ owner's agent. Owner/Agent Signature //Telephone No. PERMIT FEE: $50.00 iI174eet n/� a �q� ¢f§aialUseOnly It t ommonweaGf�ro o//ria ac�ueeffa • GAR -Z9 j cD ✓ it=mit c7Ire (7 Jewlced Permit No. . 1+=ns e t ' sParfmanl o�} t)ecupancyand Fee Checked�� I.t"' occupancy OF FIRE PREVENTION REGULATIONS 'ev.1107] eaveblank • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with thaMassachusetls Electrical Code(MEC),5221 CMR 1200 (PLEASEPRINTININK ORT EALLLVFORMATIOV Date: City or Town of: ftfl(�U _ To the Inspector of Wires: • By this application the undersigned vesnotice ofhiqorher intentie t o erformtheelectricalworkdescribedbelow. • • LI/dation(Street&Number) I2. 1:501(Wood Ci( , (Q i l ✓ of Owner or Tenant q/ ' ' / Telephone No.114'I a Owner's Address 5uIa- Isthis permit inconjuitttonwipt abufldingpermit? Yes 0 No (CheckAppropriate Box) Pur'poseoYEuilding W1,I1t1'l,ii Utility Authorization No. Existing Service___ Amps ' / Volts Overhead 0 Undgrd 0 No.of Meters • New Service _ Amps / Volts Overhead Undgrd❑ No.of Meters N• amber of Feeders and Ampacity n Location and Nature of Proposed Electrical Work: G•, / , •• a Com'Jenne the o/lowin:tabu in, bewaivedb the Ins actor o Wres. No.of Recessed Luminaires No.of CelL-Snap.(paddle)Fans Transformers KVA • No,of Luminaire Outlets No,of Hot Tubs Generators KVA 'o.e' mer:ency Mg's'g No.of Luminaires Above Swimming Pool , nd, ❑ : nd.- ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones I o.o'letectonaD • No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. ToTota No.of Alerting Devices No.of Waste Disposers •eat'ump "-umber„-,ons_-„,.,,,,,$_. , No.o elf- ontaine' _ P Totals: ,Detection/AlertingDevices Local❑Municipal No.ofDisliwashers Space/Area Heating KW Connection ❑ Other Securt ystems: No.of Dryers Heating Appliances ICW No.of Devices orE.uivalent No.of Water No,of No.of Data Wiring: . Heaters KW Signs Ballasts No.of Devices dr Equivalent • Telecommunications Wiring: IYo.HydromassageBathtubs No.of Motors TotalUP No.of Devices or E. ivalent OTHER: Attach additional detaillfdesired,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 [V7 BOND ❑ OTHER 0 (Specify:) X certib,under the pains and penalties ojperJury,that the information on this applied=Is true and complete. p . FIRM NAME: 'e CO (115L0W 'Gu.idyl . d- Bl' ,, s l,U .)c ' • LIG.NO,: 72 `� /] r 1 LIC.NO.:oO—S�`f� _ Licensee: Iafig ) i-.Int0 Signature (If applicable, Bus.Tel,No.'X08 n Itenble,enterr exem4"Lh the license number line.) C4 ' L' r too rine : t art 01 ' 0 b/o AItTe1.No.:�— Address: �, +Per M.O.L.c.147,s.57.61,securitywor requ'vesDeparknentofPublic Safety"S"License: Lic.No. ��- �r OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally t� required by law. By my signature below,I hereby waive this requirement I ant the(check one)❑owner ❑o'wner's a nt r cPOwner/Agent • PERMIT E: e„ Signature Telephone No. I. • • • A The Comrnorwe�ltk of Massaclusetf sl „ye. AePaptment ofndustrZaZAcoidenisI �= I CongressStreet,Suite 100","0 • ' `, Boston,1114 02114-2017 Workers'CompensationwwW.masygov/dta ?OBE InsuranceAffidavit:General$usinesses.. MED MT$T�'PERMITTINGAUTHORITT A�mlicantlnformation Business/Orgatrization N Please PrintLe.ibi Name:E.F.WINSLOW PLUMBING&HEATING CO;,INC Address;8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,M ' A 02664• Phone#:608-394-7778 Are you an employer?Check the appropriate box: Type(required): 1.0Iamaemployer with��employees(full and/ 5. �R5. 0Retal or part-time).* • 2.0 Iamasole proprietor orpartnership and have no 6 QRestauranUHaz es( cstablshment • employees working forma in any capacity. 7. 0 Office and/or Sales(incl real estate,auto,etc.) 3.0 [No workers'comp.insurance re We are a corporation and its officers have 8. �]Non-profit • their right of exemption perpc.152, exercised eha 9. QHntertanurent $1(4),andwehava no employees.[No workers'comp.insurance required]+ 10•Q Manufacturing 4.0 We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees.[No workers'comp.insurance req.] 12.0 Other Any • applicentthatchecks box#1 must also 5U out the n aplipomthaffmushaox#1e mustd sofitthemselves, section below showing . geoizarion should chec&hox#I. hutthecorporntion hes g� w°rk�'oompensatioripolicy information. other employees,a workers'compensation policy is required eadsuch an am an employer providing workers' rovidingworkers'cinsurance for my employees. Betowtkepolicy information. ARROW MUTUAL INSURANCE COMPANY Company sresAddress:23 COMMONWEALTH AVE ty/State/Zip: CHESTNUT HILL,MA 02467 • Hey#or Self-ins.Lie.#1821A Each a copy of the workers,comp ensat ott policy declarat on page (showing the policy number and expiration lure tosecurecoverage asrequired under Section25 Hxpiratonbate:01/01/20 l up to$ecure.00 ana/or ono- imprisonment, A ofMGL 0.152 can lead to the imposition of criminal penalties of a tp to o$1,5 0 a 0daa and/or the violator.pson ent,as well as civil penalties in the form of a STOP WORK ORDER and a fine estigations of the DIA for insurance coverage verification,0ppy°fth s statement may be forwarded to the Office of hereby cern —�— enaltieso perjury that the information provider1above Lsirueand correct iature• 4 .Gfl.9 ' e#•508-394.7778 Date: • (Total use only.Do not write in this arery to be completed by 0101 or town official • ty or Town: i UfrgAutho (Circle one): Permtt/License# Board$(Health 2,$uildingDepartment 3. )tear CitylTownClerk 4.LtcensingBoard 5.Selectmen's Office 'tact)arson Phone#: • 1410.11sssgovidia