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Home My WebLink AboutBLDE-18-002524 OP Commonwealth of OfficialUseOnly�' Massachusetts Permit No. BLDE-18-002524 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.1/071 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:10/30/2017 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) 33 CIRCUIT RD WEST Owner or Tenant BRAY DOUGLAS R Telephone No. _ Owner's Address BRAY BONNIE J,72 OLD SOUTHBRIDGE RD, OXFORD, MA 01540 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check r}fl opriate Box) Purpose of Building Utility Authorization No Existing Service Amps Volts Overhead 0 Undgrd N' n New Service Amps Volts Overhead 0 Undgrd o eta Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Service panel replacement&install receptacles&s � 4.4b, Completion of the following table raj lnd'/7ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total TransformersKVA No.of Luminaire Outlets No.of hot Tubs Generators KVA i No.of Luminaires Swimming Pool Above 0 In- ❑ No.of Emergency Lighting I/////. /n grnd. grnd. Battery Units T (7 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. ,Tl.00tasl No.of Alerting Devices No.of Waste Disposers . Heat Pump Number 'Eons I 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 Device or Eauivalent OTHER: Attach additional detail if desirecl 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) 0 owner 0 owner's agent Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 l ecree f r.)(su1462) l(f z9 a7re C QA-74 igq. 1 c 2-0,2_457) ./ f n aa II MM�� // Official Use Only Commonwealth of///aseachuaett3 i, �t cy cc77 Permit No. �[JeparEment o`Jire Serviced Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS ev.1/07 •, � [R ] (Ieaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEF),527 CM/R�12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO VATION) Date: 10/G2(0 / i 7 ByOCity or Town of:Y(orrn n jail ((Alf,J I 1 To the Inspector of Wires: • this application the undersi d gives notice of hi 9r h.a to mo o rfo the electrical work described below. er) Location(Street&N tuber) �ay ( r'c oil-I ti H Ip)Pc1- _.;8 y — P-E-7 P t J OU `D 'clepho No. Owner or Tenant --7 a1 T7 i.� t �j ! ` Owner's Address a r) (� ,Snt cr>r'IOt9-, Rd Vkkn rl Appropriate Is this permit in conjilmo n n��withgqa ilding permit? Yes 0 No ❑ (Check PPriate Box) P • Purpose of Building ` WP.r7I n9 Utility Authorization No. /�• Existing Service_ Amps / J Volts Overhead El Undgrd CI No.of Meters 'v New Service _ Amps / Volts Overhead❑ Undgrd❑ No.of Meters ,___ 2 Number of Feeders and Ampacity Lo at'm and Nature o Pro:osed E ectrical Work: (/ j II I Its aim 6 c e eneast/ a*.�� . .. IeCfricSo�e d 2PI :pip NT'e , •r try' " Completion of the following ma ,e wet d by t e Inspector.f Wires. ... No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA • No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- No.of Emergency Lighting No.of Luminaires Swimming Pool grad. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump _Number,fI-�T_ons�1IKWry, No.of Self-Contained No.of Waste Disposers TotalI 1 I Detection/Alertina Device., s Municipal Other rte^ No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ OC) Heatin A pliances KW Security Systems:* No.of Dryers g P No.of Devices or Equivalent No.of WaterNo.of No.of Data Wiring: KW Heaters Signs Ballasts No.of Devices or Equivalent 'Telecommunications Wiring: t— No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent W OTHER: Attach additional detail ifdesired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When 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 Er 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 NA :: gc (D/OSLOW Pt-L.v, ThrMo °" fie �3 lit. • LIC.NO.: J,�`�lC� Licensee: /41Clk.11L.() /14tWIOU Signature ..ter LIC.NO.:9/S7ii (If applicable,enter `exern t"in the license number line.) I Bus .Tel.No.•SG3 Address: 1 /1- 077-00/(-) Giftea 5Uttil4 ib4" L isCinott ri- t1q O>44 Alt.Tel.No.: *Per M.C.L.c.147,s.57-61,security work requires Department of Public Safety"5"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 art 1k�_d Owner/Agent I PERMIT FEE: $ Sr' Ov U Signature Telephone No. •• '\ The Commonwealth of Massachusetts Rte' 1 -ML t Department of Industrial Accidents _ � 1 Congress Street,Suite 100 —'TE Boston,MA 02114-2017 ViE 49 .'PTwww.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO., INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. Phone#:508-394-7778 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 10 employees(full and/ 5. 0 Retail or part-time).* 6. 0 Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. • [No workers'comp.insurance required] 8. 0 Non-profit • 3.❑ We area corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees.No workers'comp.insurance required]** 4.❑ We are a non-profit organization,staffed by volunteers, 11.0 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 information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#I. lam an employer that is providij.rg workers'compensation insurance for 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.Lic.#1821A Expiration Date:01/01/201g Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). I , 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/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 cerci ,r the aifas and enalties o perfury that the information provided above is truQee and correct Signature: • ,.w, i,.,... Date: la /3/ Phone#:508-394-7778 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person:- Phone#: • www.mass.gov/dia cit• 9R TOWN OF YARMOUTH • a'o• BUILDING DEPARTMENT o _ -y 1146 Route 28, South Yarmouth, MA 02664 -N Th;t. n ,,,—i ,5•, 508-398-2231 ext. 1263 Fax 508-398-0836 E-, ,.::. K. Elliott, Inspector of Wires kelliott(a varmouth.ma.us November 29,2017 Richard Melvin E. F.Winslow Plumbing& Heating 8 Reardon Circle South Yarmouth,MA 02664 RE: 33 Circuit Road West,West Yarmouth Permit Number: BLDE-18-002524 Dear Rich; The above noted location inspection failed to pass for the reason(s) listed. Article 230-50(B)(1) Protection from physical damage. 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 K.Elliott, Inspector of Wires