The URL can be used to link to this page

Home My WebLink AboutBLDE-18-002067 �. . Commonwealth of oft;eialuseonly ' �� Massachusetts Permit No. BLDE-18-002067 • - �--'� BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/07j 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:10/10/2017 City or Town of: YARMOUTH . To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 40 CIRCUIT RD WEST Owner or Tenant MCHALE KEVIN,J Telephone No. Owner's Address MCHALE ANNEMARIE C,4 BROWNING RD, NATICK,MA 01760 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Ap, , ' iate Box) Purpose of Building Utility Authorization No. O Existing Service Amps Volts Overhead ❑ Undgrd 0 o.o tei - New Service Amps Volts Overhead 0 Undgrd ❑ C N4A Number of Feeders and A y ^ Location and Nature of Proposed Electrical Work: Replacement furnace and add CO detector. c/4 �/,/A�l� Completion of the following table may be w V for of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of oo V env Transformerstoo, A No.of Luminaire Outlets No.of Hot Tubs Generators / �s ` KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.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 Initiatina 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 1 _ Totals: Detection/Alerting Devices _ _ No.of Dishwashers Space/Area Ileating 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: Ileaters 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 ifdesire4 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 (Ifapplicable,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,1 hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 RE BSc!( ` (to-cr CP.AwL- SpACt) "/'4o C . pp ee,, q�q r Official Use Only l.ommonw¢alrh o�Yyla39acha7af/d 8(�� /\/ { cc� ec// pp Permit No. -oe, N Thapartmee t'a�Jir¢Jervicee Occupancy and Fee Checked 4 '�4 BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] eaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with theMessacbusettsElectrical Code rC),527 s P 12.00 (PLEASE PRINT IN INK OR 'EALL INFORMA IOR ) Date: lb •e City or Town of: I it at 1rik iiie5 To the Inspector of Wires: By this application the undersi: ed givesxrotice Utak o her;tendon .p-rform .e electrical work described below. LceaHon(SireetlANu. .er) 1 !U' _ L°!�' 1 / '1�]/ Owner or Tenant a Telephone No, a�.'� "(IbtJj'F� Owner's Address f[ OH • nri■•`y�uI' a • Is this permit in conjunction wi bruildi,:permit? Yes No 0 (Check Appropriate Box) / Purpose of ding ,J Lmps I i n q Utility Authorization No. ________-- r'-')o/ Existing Service Amps I J Volts Overhead 0 Undgrd❑ .No.of Meters New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters 1^ Number of Feeders and Ampacity , {.. LocafoiandNatureofProposedEletrfcal ' ork: „ �r� . . �'�;€� % - hi •i.wI 1 l a t1 -% ISI - Ig er 4- SMS l�.N*+�ll�._ 11 aid' Com.letiono the ollowi :table m. bewaivedb the Ins seatoro Wires. r 'o.of No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transforrrrers ICVA Generators KVA . . uminatre Outlets No.of Hot tubs __ — Above I6 •merge :r '� No.of Luminaires Swimming Pool grnd. 0 band. Batte Units "" o_ofReceptaclQ..0@r1afY"2' "1_.li :37EC111Burnft4.._. . P.hEARMS Nn.ofZones `o.of Detection and No.of Switches No.of Gas Burners Initiatin:Devices No.of Ranges No.of Air Cond. Tons 'No.of Alerting Devices No.ofwastepisposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/AkrtmgDevices Municipal 0 Ddter No.of Dishwashers Space/AreaHeating Kw LoealO Connection 5ystems:* No.of Dryers Heating Appliances Kw ecurity No.of Devices or Equivalent No.of waterKWNo.of No.of Data Wiring: V----• Heaters Signs Ballasts No.of Devices or Equivalent Tele [ No.HydromassageBathtnbs No.of Motors Total HP No. o of Devices or E.uivalant OTHER: Attach additional detail if desired oras required by the Inspector of Wires. Estimated Value of Electrical Work Attach 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 (BOND 0 OTHER 0 (Specify:) I certify,under the pains andpenaliles of perjury,that the information ap?ls appli on is true and complete. FWMNAME: E P Wtln/Staa LIC.NO.:'Z 2 d// LIC.NO.:/I Ifapplica en er xm �&'4 Yin/ Signature B .Tel.No.•�D Pte_a2-27t A applicable enter"exempt"to the C.g number line.) 2 Address: L t .t . C.0(s&. S : /� d 64 Alt.Tel.No.:-- — *Per M.G.L.c.147,s.57.61,security work req • es Department o Public Safety"S"License: Lie.No. _____. — OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coveragnormally nt required by law. By my signaturebelow,I hereby waive this requirement. I am the(check one 0 owner owner's `� ' Owner/Agent PERMIT FEE:Sad 1 b'7 Signature TelephoneNo. 1 • • r • • • • 1147-1=41 � t The Commonwealth of Massachusetts _1= DepartmentoflnolustpialAcckledi =�wife: Congress Street,Suite 100 •-Tt. Boston,Xi 02114-2917 • Workers' WB'w 'sgov/ilia • Com• pensation Insurance Affidavit:general Businesses. alicandYnformaatfoat TO EDP'PDWITHTnPERitfiri •GAUPHGRITI', Business/OrganizationName:E.F.WINSLOW PLUMBING&HEATING CO.,INC ]ease Print Le 'm]• Address:B REARDON CIRCLE • City/State/Zip:SOUTH YARMOUTH,MA 02664 phone#:508-394-7778 Are you an employer?Check the appropriate box: 1.0 I am a employer with 68 employees 5•5. 0Rs etail (required): or part-time).* —� 2.0 Iamasolo proprietor orpartnership and have no 6. QRestauranf/Bar/EatmgEstab ent employees working for me in any capacity 7. 0 Office end/or Sales(incl.real estate,auto,etc.) 3,❑ [No workers'comp,insurance required] 8. 0 Non-profit We area corporation and its officers hav exercises . 9.-f-ntertainment — - .. - tfie'urrg3tofexemptionperc.l5�$7(a)rane�a —•-- no employees,:To workers'comp,insurance required: Q Ma°°fa°luring — -- - - Q w thno emploare y:: tergamga{[o�started b voluntee� -calth'C r �— -- -- —••—�—•— P y:•j.No woifCera comp,insurance req.] 12. - ' *Any applicant that chocks box#1 must also Other policy p ' • ' ` . *Anypplica rt that chocks an box#1exemptedmustfill outfits sectionbelow showidgtheir workers'compensation olic infuriation, organization should check box#1, themselveq but the cwpotattoahas ot6eremployeees,eworkers'compwsetlon policy isrequtadand suchen I -.anenyloyerthattsprovidngw sr cera k o y oniruurance for • employees. Below isthe Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY policy Information Insurer's Address:23 COMMONWEALTH AVE •• City/State/Zip: CHESTNUT HILL,MA 02467 I Policy#or sans.Lio.#1521A 17 Attach a copy of the wide::::::::: :::::::: iratione. 112 Failure to secure coverage as required under Section 25A of MGL o.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 oftheDIA for Insurance coverage verification. Idohereby eerti, fperjuryenaltieso •r ihatthetnformattonp rovidedabavetstrueandcorreet I Shoal—we: ria' 'hone :568-394-7778 Official use only.Do not write In this are;to be completed by city or town official City or Town: Issuing Authority(circle one): PermitLtcense# I.Board of Health 2.Building Department 3,City/Tont perk 4,Licensin Hoard 5,Selectmen's Office 6,Other Conteetre/sou: Phone