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Home My WebLink AboutBLDE-19-002407 ^f,n a 1 7� Commonwealth of Official Use Only hb Massachusetts Permit No. BLDE-19-002407 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked f 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 PRLNT IN INK OR TYPE ALL INFORMATION) Date:10/23/2018 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) 20 WILDFLOWER VILLAGE Owner or Tenant DENNIS DIANE Telephone No. Owner's Address 5 MIAMI RD,OAKDALE,NY 11769 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 HVAC. 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- 1:1No.of Emergency Lighting Rend. grnd. ,Batters,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 ❑ 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:) /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 LTC.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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 (�A r*/"e m.2 fiVAC°K/a e �-\ Com unavoca of MaaeackimeEfs Offici(�lAUse�O�n-Ily� / � v ;;�� cc77 Permit No. Thefrartment ol),}1ra Serviced a_��_a Occupancy and Fee Checked • n,; ,� BOARD OF FIRE PREVENTION REGULATIONS [Rey.1/07j peaveblank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All woricto be performed in accordance with the Massachusetts Electrical Code(MEC),527 eta 12.00 (PLEASE PRINT IN INK ORBALLM'0 1TI Date: 1 O I I' L L City or Town of: `(fir ry1Q(/th To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to . orm the electrical work'described below. . Lo'eation(Street&Number) I y A - / /n, 'aid- 016 • Owner or Tenant t%i,f ta & ‘ Telephone No. j 7q Owner's Address t/ 'i ,' ltin7A ts, r • e Is this permit in conjuctionvyit�iabuildingppermit? Yes 0 No (Check Appropriate Box) Purposeorsuilding ' We YU7 Utility Authorization No. Existing Service_ Amps J / Volts Overhead❑ Undgrd❑ No.of Meters — New Service _ Amps / Volts Overhead 0 Undgrd 0 No.of Meters __ Numberocatioeofnd ''ofFeed IAmposety i1a; Lt catie and a f Proposed Electrical Work: A • a I a . A Completion of the following table may be waived by the Insp ct9Lo Wires. No.of Recessed Luminaires No.ofCeil:Sus . addle Fans No.of p (Paddle) Transformers INA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.ofEmergency Lightmg No.of Luminaires Swimming grad. 0 grnd. 0 Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS IN°.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.oPAlerting Devices No.of Waste Disposers Heat Pump Number Tons,__,X'W No.of Self-ContainecC _ Totals:i Detection/Alerting Devic es Municipal Other No.of Dishwashers Space/Area Heating KW Legal Connection security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent o•ofWatero.of Nit.of Data Wiring: CD Heaters KWSigns Ballasts No.of Devices or Equivalent No.I1 dromassa eBathtubs No.of Motors Total HP TelecommunicationsNrEqui al Y g No.of Devices or Equivalent ,ss' OTHER: —•f- Attach additional detail ifdesire4 or as required by the Inspector of Wires. C./ ) Estimated Value of Electrical Work: (When required by municipal policy.) i 8 . Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waivedby 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 M undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Fl BOND ❑ OTHER 0 (Specify:) • • I reify",under the pains and penalties of perjury,That the lnformatton on this application Is true and complete. Cr FIRM NAM: c &WN5Low PGuti &tiOLa d" 4s/41p 4,O.JIu-' ' • LIC.NO.:2� Licensee: ( kz-n PI tI U(N Signature`///� frt. � LIC.N0. t S��R �IQPPilcable,erurr"ex m.t"lnthe license n berltne.) H Ens.Tel.No... Address: '' L' 4 MA) rtCLE Uitu ;de Ott tAt 0 6AIt.Tel.No.:_�— ee 1' *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 am the(check one ❑owner ❑owner's a ant. Signattureura Telephone No. Own nt PERIM'FEE:$ 6' 1' .. b t =--�� t The Conurwnwealth of Massachusetts • • • • A " 1— aepartrrient oflndustrialAccidents si,—Burr,. 1 Congress Street,Suite 100 Boston,MA 02114-2017 ; .a+ • .. wwWlndssgoy/die . 4.I \ i worllars'.compensation InsuranceAftidavit:General Businesses.. TOBEF A.'licant Information �EDmT$THSFE I n10AVplease PrintTaoduTv, Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO.,INC Le•ibl Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. Phone#:5083947778 Are you an employer?Check the appropriate her 1.0 I am a employer with Business Type(required): • or part-time).* emPioyees(full and/ 5. ❑Retail • 2.0 soleIamaproprietororpartnersh P and have 6. QRestamanpBar/EatngEstablishment employees pro ' no k ng for me in any capacity. 7. 0 Office and/or Sales(incl.real estate,auto,etc.) wor[No workers'comp.insurance required] 3.❑ We are a corporation and its officers have exercised 9. 0 Non-profit • their right of exemption per c.152, 14, we 9. ❑Mnufcurint 4.[] no employees.[No workers'comp.insurance and eq have 10.Q manufacturing We are anon- rofit orP msurancerequred]++ with no employees, gamzat on staffed by volunteers, 11.0 Health Care Airy applicantthatemplhecica [No workers'comp.insurance req.] 12.0 Other box#1 must also fill out the section below showing their workers'compensation policy infoimation. organization tion sh to d check kbox exempted themselves,but the corporation has other employees, aworkers'compensetion policy is required and such an ' I am an employer that Is providing workers'compensation insurancefor my employees. Below Is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 • Policy#or Self-ins.Lin#1521A Exir Attach a copy of the workers'compensation policy declaration page(showing the pot pirationolicy numberate: 0and expiration date). Failure,to secure coverage as required under Section 25A of MOL 0.152 can lead to the imposition ofcriminal 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. 13e 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 certt enaUles o perjury that the Information provided above is true and correct Si: store: Date:one;:508-394-7776 7 'h Official use only. Do not write fn psis area,to be completed by city or town official • City or Town; Issuing Authors Permit/License icense# 1.Board ofHeaIttr(2guildingDepar�ant3.Ci • /To • • 6.Other t3 wn CIerk 4.Licensing Board 5.Selectmen's Office Contactrerson: -hone#: wwwmass,gov/dia