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Home My WebLink AboutBLDE-19-002351 Commonwealth of Official Use Only trO Massachusetts Permit No. BLDE-19-002351 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.I/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:10/19/2018 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) 124 PLEASANT ST Owner or Tenant CAVANAUGH ROBERT J Telephone No. Owner's Address CAVANAUGH NANCY A, 124 PLEASANT ST,SOUTH YARMOUTH,MA 02664 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 ❑ No.of Meters New Service Amps Volts Overhead ❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: HVAC 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 ❑ In- ❑ No,of Emergency Lighting grnd. ed. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initlatint Devices No.of Ranges No.of Air Cond. 1 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 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:) I certify,under the pains and penalties of perfury,that the information on this application is true and complete. FIRM NAME: RICH M MELVIN Licensee: Rich M Melvin Signature LIC.NO.: 21829 at 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"5"License: OWN'ER'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 l,.omrrwm ea&o/tt/aosaehade(L4lisclibilUse „ =it Permit Nm 6 C ��5 Merriment ai.}6rB�BratC81 =-jli ff Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS ey 1/0 -4,„7-"F.-71 [R 7] (leavablank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance vdth theMassachusetts Electrical Code(MEC),527 CMR12.00 . (PLEASE PRINT IN INK ORT?E ALLRFORMATI011� Date: IO I I S II A.1 — City or Town of: (t(/yl6 N k To the Inspector of Wires: By this application the undersigned gives notice of his or her inten'.n to .erfonr the electrical work described below. , 'ideation(Street&Number) aI . t I t / /j1 rt/ 02g- Owner or Tenant a6-OwnerorTenant _ Mr/A oh Telephone No.504S 9�<< Owirer's Address •.d 6 Is this permit in conjunction witltiabuilding permit? Yes ❑ No [ir--(Check Appropriate Box) Purpose offuilding Qwetl(nj Utility Authorization No. Existing Service_ Amps / Volts Overhead❑ Undgrd❑ No.of Meters __ New Service _ Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature ofProeosedElectrl IWork; ( t fU/ntCe -'_ • C skin �, _. sskin the ollowin:table in, be waived b the Ins actor o Wires. No.of Recessed Luminaires No.of Ceil.Sus .(Paddle)Fans o.of p Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- 'No.of Emergency Lighting No.of Luminaires SwimmingPool , nd, ❑ : nd. ❑ Batte Units 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. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons .KVI No.of Self Contained P Totals: Detection/Alerti9g Devices MunicipalOther No.of Dishwashers Space/Area Heating KW Local❑ Connection o No.of D A Security Systems:* rYers Heating Appliances KW No.of Devices or Equ[valent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices dr Equivalent dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: No.H Y g No.of Devices or Equivalent OTHER: —' Attach additional detail ifdesired,or as required by the Inspector of Wires. (in V7 Estimated Value of Electrical Work: _ (When required by municipal policy.) Cr" tC Z. Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. tri INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless O the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The -r- V undersigned certifies that such �J coverage,tis in force,and has exhibited proof of same to the permit issuing office. L CHECK ONE: INSURANCE BOND 0 OTHER 0 (Specify:) • I eertl,under the pains and -- of perJury,that the information on this.application Is true and complete FIRMNA.i: . c to NSLOw •,,,,,. 3 4- e ' r ' 'I' ' LTC.NO.: LCi Licensee: tCFFA21) M gLV�N signature LIC.NO.:r2IS • (Ifapplfcable,ent-rr"exem.t"in the license n ber line.) ng i Bus.Tel.No.io8 n'le Address: - L' it JON gat �'Uit .1LL tit I D - 0 b/o Alt.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 required by law. By my signature below,I hereby waive this requirement. I ant the(check one)0 owner 0 owner's agent. Owner/Agent • I PERMIT FEE:3 Signature Telephone No. • --••• \4• • A Commonwealth ofMassachusefts The 1t.g _'_tM Ei • Department of lndustrialAcefdents ei=";rp� 1 Congress Sfreet,Suite 100 ' = Boston,MA 02119-2017 www.massgov/dig Workers'Compensation Insurance Affidavit:General Businesses:. ' TO BEk11,EDW1TETgEPERNIITpINGAUTHORITY. AsslicantTnfOrmatIO Please Print Lel ibl • Business/Organization None:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address;8 REARDON CIRCLE • City/State/Zip:SOUTH YARMOUTH,MA 02664. Phone#:508 94-7778 Are you an employer?Check the appropriate box: , 1.0 Iamaemplayerwith. Business Type(required): . or part-time).* Q employees(full and/ 5; I:Reta l • 2.0 lam asole proprietor orpartnersh P and have 6. QRestaurant/Bar/EatingEstablishment employees working for me in an no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) 3.0 [No workers'comp.insurance required]rTy' 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 Preq.] 12.0 Other "Any applicant that checks box#1 must also 8U out the section below showing their workers'compensation policy infoimation. **If the corporate officers have exempted themselves,but the corporation has other employees,aworkers'compensation policy is required and such an organization should check box#1. ' Iran anemployer Mails providing workers'compensation insurance form employees. Below is the Information Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY policy f Insurer's Address:23 COMMONWEALTH AVE City/State/zip; CHESTNUT HILL,MA 02467 • • al- Policy#or Self-ins.Liu.#1021A Attach a copy of the workers'compensation policy declaration page(showing tale policirationy numberate: 0and 0expiration date). Failure to secure coverage as required under Section 25A of MOL 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. •I do hereby cern a naldes o perjury that the information provided above is true and correct Si_ atm: • . i'. wno 508.394-7778 Date: 7 • Official use only. Do not write In this area,to be comp feted by city or town official; i; City or Town: PermiLicense#Issuin Authority(circleone): • 1.Board of Health 2.Building Department 3.City/FownClerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person:--------------- Phone#: 1 wwwmass.govidia