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Home My WebLink AboutBLDE-19-003414 • Commonwealth of Official Use Only o 1E !►i Massachusetts Permit No. BLDE-19-003414 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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 IN INK OR TYPE ALL INFORMATION) Date:12/4/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonu the etectrical work described below. Location(Street&Number) 9 PINE REACH VILLAGE Owner or Tenant ROBINSON DOUGLAS N LIFE EST Telephone No. Owner's Address ROBINSON BRENDA D LIFE EST,9 PINE REACH,YARMOUTH PORT,MA 02675-1471 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 ❑ 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 HVAC Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans I No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- 1:1No.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 1 No.of Detection and Initiating 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 ❑ 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 0 (Specify:) I certify,under the pains and penalties ofperjuty,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 CR,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 --. • 0 e epartnsent oigire&mites li s Occupancy and Fee flecked^_______;. ((�� ( BOARD OF FIRE PREVENTION REGULATIONS . [Revel/01Jleaveblank O—['7 lk APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All v oxkto bepert'ormed in accordance withtheMessechuseth Elechical Coda(MEC),527 CMR1200 (PLEASEPRINTINAVKOR •'• ALL f ORMATIONJ Date: r3/ l — . City or Town of: : (I) : II, To the Inspector ofWires: • By this application the undersigned:yes notice ,'•orherute' ont°perf°rtht alecti w describedbel.w• 0 1 ` ' 4 r• w . . 0 Li e olt 0)-61c LUdation(Street&Number) to (� , Owner orTenant ) e 09 AS a t s $ TelephoneN0•5Qi.3_a--- Owner'sAddress a C Is this permit in conjunction with a building permit? Yes ❑ No (CheckAppropriateBox) PnxposeoYBuIlding DWell l)R(d Utility AuthorizationNo.___ _________ ExvstingServica Amps ' I Volts Overhead Undgrd❑ No.of Meters __. N`IeW Service Amps / Volts Overhead Undgrd 0 No.of Meters ______ Number olFeeders and Ampacity (Gn t Locactionandatureo,ProposedElectricalWork: f ce 1 at (WI • ,4s I\t ho . • Com teftono the otlowin tabnlenntfaybewatved6 thelnsHictor When• To a No.of Recessed Luminaires No.ofCeiL-Snap.(Paddle)Fans Transformers EVA VA No.of Luminaire Outlets No.of Hot Tubs Generators • Ho.o mar ency g No.oYLuminaires Swimming Pool red- ❑ nd. � Bette Units Na.of Receptacle Outlets. No.of 011Burners gig&ALARMS No.of Zones o.o eectconan • No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total- Tons No.of Alerting D evices eat um umber ons 0.of e - ontaine No.ofWastaDisposers Totals: Detection/Alerhn Devices umcipa Other No.of Dishwashers Space/Area KW LOcal❑Conneetion • court. pstems: No.of Dryers Heating Appliances ICW No.of Devices orE nivalent o.o ater No.of No.of Data Wiring: HeatersKW SIa Ballasts No.of Devices orE nivalent e ecommunications firingg: • No.HydromassagaBathtubs No.oflfotms Total No.of Devices orE rvalent OTHER: • Attach additional detail)f desire4 ores requfred by the7nspeclor of Rtes. EstmatedValueofElectricelWork: (When required bymunicipalpolicy.) Work to Start: Inspections to be requested in accordancewith MEC Rule 10,awlupon 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 hes exhibited proof of same to the permit issuing office. • CHECK ONE: INSURANCE(� BOND 0 OTHER 0 (Speoify:) • d • HO Icert fy,under the pains and penalties of perjury,that the in ormailon on this application Is true and complete. FIRMNA C IV 0.510) •G up, . to a• aed , / • LIC.NO.: J ,I/ LIC.NO,:_ ::. �� e ( Licensee: (G(} M��Vlly Signature Dg. Qy '? ? , Bus.Tel No. .._2_enr-rr ax m, "In thellcensen nigher 'r Address: - ,L I-4/ Dap lfZ 5 4 jet a; Uk ` b a� Alt.Tel.No.:_--______ �� o *Per M.O.L.c.147,s.57-61,security wor reaukes Department of Public Safety"S"License: Lit%No. _ — c OWNER'S INSURANCE WAIVER: Iamaware that the Licensee does not have the liability insurancecoverage nomellnt. • fewner/bylaw.By my signaturebelow, Ihereby waive this requirement. Ismthe(check one Downer 0 cr Owner/Agent P},R III'FEE:$ `% 1/ Signature T• elepfioneNo.�-- • 4) • • • •The Commonwealth ofMassaclaseis1.� _ l Department lndustYial4ccide nf • slc 'L • I CongxessStreefSurtel00.- C=g . Boston,MA0114-20X7 ' •%•:• • www.masygov/dla • Workers'Compensation { 'IOU FILED Insurance Aff davif:CeneraI$ns nesses.. le ificantInformation WIT$THE I ILITING AUTHOR ITY, ;usiness/OrganizationName:E.F.WINS LOIN PleaseprintLe'ibl Wclress:8 REARDON CIRCLE W PLUMBING&HEATING Co.,INC • ity/State/Zip;SOUTH YARMOUTH,MA 02864. e you an employer?Check thea Phone#:698394 9778 I am a employes with appropriate box: or art-' r employees Bus Hess type(requ red); JP lime)• (fill and/ S. []Rafal 1amasole proprielprorpartnership and have no6. EIRestauranalarating Establishment II10 workers'yees oco formerking in any capacity. 7. 0 Off a and/or Sales(Mama]estate auto,etc.) • empWearer Workers' corporation p Insurance required] • their Wee right od its er p Cars have exercised 8. ❑Non-profit no emplhtof exemption Worker' 152,§1(4),and We have 9' 0 Entertainment • ] noearaanon-proftorrkers' amp 1°suraneatequired]+ 10.[�manufacturing • with no employees.(No workers'comp. by volunteers 12. Otherealth Care Com peliantthetchak4box Yrmust akofV p'msU1a°rsreq•] I2.[� �rA shoeorate o0icers have ex wnselvt�0aecfion below showingihejry�r . anon should cheek bond]. themselves,hurfheco kesa'come V1�Playerlludls roVi • ryoranoaha4otheremPlor'ees,aWarkers'�componvsb�o�jo�bm{uuedend such an p daragworkers'co floe ployeryNamp:ARROWorkTU mpensationinsurance form y AL INSURANCE COMPANY employee Belowirll:epolleyiuformollon :is Address:23 COMMONWEALTH AVE atetZip: CHESTNUT HILL,MA 02467 9 or•Self-ins.Lie.#l821A a copy of the workers,compensation policy dad /� . tosecuofthcoverage oraton a Expiration Data:Of/01/20 Y as required under Sect 2 can lead ed to the the policy numberofcrim nalexpirationenpenalties ofa. osec e.00and/oroneyearimprierSecn�25AofMGLc•152canleadtotheimpositiontrimnal b$l,50adayd/oronthearmpr,on taswell ascivil ORDERDsiainafa slims$250.00 a the y against g nst the advised that a copypeffii sta in the form bfa STOP WORK ceof afna antro coverage verification. Ct'this statement may be forwarded to the Office of 'by cera . enal[les o • r ` pP'7a'y�+oifhalnformotlonprovldedaboveistrueandcartect 508394.1778 Date: • lure only.Donolwrttefnpitsare;to • be completedby city or town ofllclaL Town: • Aathority(chaleone); Permit/License# 1 of$ealth 2.Bn ldtngl)epnrtmaat 3• , City/Town-Clerk • 4,LtcensingBoard S.Selectmen's Office Person: • Phone#: Wmass.gov/dt4