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HomeMy WebLinkAboutBLDE-19-002184 Commonwealth of Official Use Only r Massachusetts - Permit No. BLDE-19-002184 V 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:10/12/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives no ice o is or Cr in en ion o pc omr cal: lea work d',-d below Location(Street&Number) 315 LONG POND DR rIs el t 1 Owner or Tenant COOPER ERICK W L Telephone No. Owner's Address 131 PLEASANT ST,SOUTH YARMOUTH,MA 02664 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 ❑ Undgrd 0 No.of Meters New Service i! Amps'•. Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity-4 Location and Nature of Proposed Electrical Work: Install generator. 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 1 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 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 ❑ 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 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 SignatureTelephone No. PERMIT FEE:$75.00 ---rativ„„a cf uQYOD (4, 6 *die rte? Ce-( C ) poems WJ0 gy p) n- fia Ka ) y Commanweaitk oi/r/addachulette OfficialUse Only 1 0 'r p 't cc;� cc77 n PermtNo. . 9 nmmE 2epartmant of,}ire Serviced f=` Occupancy and Fee Checked '"a -/ BOARD OF FIRE PREVENTION REGULATIONS [Rev 1/07] (1eavebiank) — • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance withthe Massachusetts Electrical Code •C),52 CMR 2.0' (PLEASE PRIM LVINK ORTYPEALL INF RMATION) Date: I ir City or Town of: N6[in du-L, To the Inspector of Wires: • By this application the undersigned gives notice of his orb intent on to perform the el c.dcal work des ri.ed below. Location r Location(Street& umber) L I/( s L. 1 1 t, I I dr • ' ger"1 Owner or Tenant MQVi sp*Ujn Telephone No. /a 9 Owner's Address S clifA L Is this permit in conjunction wit puildingpermit? Yes 0 No E (CheckAppropriateBox) Purpose oPBuilding .O we�If n a) Utility Authorization No. Existing Service_ Amps • /./ Volts Overhead El 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: Gen part-Or tv\ -J.- '1 i On 4#"-F;NA`' Com.letiono the oflowin:table as• be waived!) the lnsoteoro Wires. • No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans o.of p Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above fa- 'No.ofEmergency Lighting No.of Luminaires Swimming Pool . nd. ❑ : d. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of Detection ana • No.of Switches No.of Gas Burners No.Initiating Devices No.of Ranges No.of Air Cond. Toast No.of Alerting Devices No.of WasteDis Disposers -neat Pump Number Tons KW No.ofSelf-Contained— _ P Totals:I I I Detection/Alerting Devices No.of Disliwashers Space/Area Heating KW Localitiches No. 0 Odra No.of Dryers Heating Appliances KW -Security ofDevice: y g PP No. Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWSigns Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent • OTHER: Attach additional detail if desired or as required by the Inspector of Wires. Q Estimated Value of Electrical Work: (When required by municipal policy.) c..4360 Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. C l�---1" INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless ,D-- + ` the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The C r undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. V �. CHECK ONE: INSURANCE [i BOND ❑ OTHER ❑ (Specify:) © I certify,under the pains and penalties of perjury,that the in ormation on this application is true and complete. FIRM NAME: :c fp •t'5CLW •Lit (r e.- 5 ' r - CO . LIC.NO.: ?j �! Llcenseeir Naim (Lo /1 tL.Vrit) Signature�� LIC.NO.:o-1 517PA (repotted::,ent-r"exem.t"In the license?wither line) ,I Bus.Tel.No.•'.dL Address: - L- '/LJOi) 6 Kat 501, .1 I Olt ' 0 bAlt.Tel.No.:—__— *Per M.O.L.0.147,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 am the(check one)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE:5 Signature Telephone No. •• 4 r The Commonwealth of Massachusetts •=:gip- i Department oflndustriatAccidents P„,-.Si 1 1 Congress Street,Suite 100 � Boston,MA 02114-2017 V orkers' wwwmass.gov/dia Compensation Insurance Affidavit:general Businesses- TO BE MED WITH THE PE usinesses..TOBEpg,EDWITHTHEPE yp GAUTHORITY. A. alicantInformation 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#:508394-7778 Are you an employer?Check the appropriate box: 1.[✓ C)I am a employer with Business Type(required): . orpart-time). " —emplayees(Ill and/ S. ORetail • 2.0 I am a sole proprietor or partnership and have no 6 QRestauranUBar/Eat ng Establishment • employees working for me in any capacity. ? El Office and/or Sales(incl.real estate,auto,etc.) 3.0 [No workers'comp.insurance required] 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 4.❑ no employees.[No workers'comp.insurance required]++ 10.[]Manufacturing We are a non-profit organization,staffed by volunteers, I1.[]Health Care with no employees.[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 infoimadon. **If the corporate officers have exempted themselves,but the corporation has otheremployees,a workers'compensation policyis organization should check box#1. pe ' required and such an ' I am an employer that is providing workers'compensation insurance for employees Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Beiowkthepolicyinformattorr Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 Policy#or Self-ins.Lie.#1821A /47 Attach a copy of the workers'compensation policy federation page(showingthe a ionDcy nmberate: r1/20and ex piration 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/cr 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cerd s •• .enalttes o perjury that the information provided above Zs true and correct. Si:nature: 4 .� Date: - - ' 7 'h. a#•508.394-7778 • Official use only.Do not write in this area,to be completed by city or town official City or Town: Issuing Authority(circle one): Permit/License# • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.masagov/dia #-- t'AiTOWN OF YARMOUTH tt4, BUILDING DEPARTMENT oy . y 1146 Route 28, South Yarmouth,MA 02664 ��; 508-398-2231 ext. 1263 Fax 508-398-0836 yr K. Elliott, Inspector of Wires kelliott(avarmou th.ma.us November 28,2018 Richard Melvin E.F.Winslow Plumbing& Heating 8 Reardon Circle South Yarmouth,MA 02664 Location: 315 Long Pond Drive, South Yarmouth Permit Number: BLDE-19-002184 Dear Rich; The above noted location inspection failed to pass for the reason(s) listed. Depth of conduit & workmanship. Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained, to the property, for the re-inspection. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth, Building Department et/ / / • K. Elliott, Inspector of Wires