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Home My WebLink AboutBLDE-19-003659 . . Commonwealth of Official Use Only E`• Massachusetts Permit No. BLDE-19-003659 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:12/17/2018 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) 87 LAKEFIELD RD Owner or Tenant CHENEY PHILIP L Telephone No. Owner's Address 87 LAKEFIELD ROAD,SOUTH YARMOUTH, MA 02664-2972 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 furnace. 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 El ElNo.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 Initiatinc 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 ICW Local ❑ Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent - No.of Water KVp No.of No.of Data Wiring: Heaters Siena 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 perfury,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 re red 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 "' -r-..-=!-- $ \ - C'ommon/ma�t�soiMaddac�.adelfa OfficielUseOnly ' f r� Permit No. 3 �[s��d�; c7 n • ll epartment'of giro Serviced • I Occupancy and Fee Checked .4,C=zte BOARD OF FIRE PREVENTION REGULATIONS [Rev 1/07jQeavebleak) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed hi accordance withtheMassachusettsElectrical Code(MEC),'27 r 12.00 (PLEASE PRINT WINK OR TYPE ALL INFO TIOm Date: I s City or Town of: _/a►_VYI n l To the Inspector •I Wit s: By this application the undersigned gives notice of his or her intention to perform the electrical work describedbelow. . LoVation(Street&Number) . L bc, a RJ S.1hn?tOtS • I9•I06.4 Owner or Tenant Pk,Ii / I„ONet/ TelephoneNo. $08 q 1373 Owitr's Address S A M E l r` t Is this permit in conjunction-�wit�h"a bu(ilding permit? Yes 0 No 2/ (Check Appropriate Box) ` PurposeoP;3uilding ' UUw�`( JUtility Authorization No. 0 Existing Service^ Amps • / Volts Overhead 0 Undgrd 0 No.of Meters __, ` • � New Service Amps / Volts Overhead 0 Undgrd 0 No.of Meters Numbtr•of Feeders and Amp acity Location and Nature of Proposed Electrical Work: GLtS Ent In a.CP • Com.lst tono the ollowin:table ma bewaived b the Ins actor a Wires. `o.of To a No.of Recessed Luminaires No.of CeiL-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators INA No.of Luminaires Above ln• `No.ofEmergencyLighting SwimmingPool Qrnd. ❑ rrnd. Battery Units `I ) No.of Receptacle Outlets. No.of 011Burners FIRE ALARMS No.of Zones of Detection 'D • No.of Switches No.of Gas Burners No.Initiating Devicandes No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Beat Pump'Number Tons .IV7 No.of Self-Contained- Totals: Detection/Alerting Devices No.of Dishwashers Local❑Munici al 0 Other SpacWMeaHeating KW Connection No.of Dryers Heating Appliances KW -Sec . Systems:* iNo.of Devices or Equvalent Pc7777ater KW No.ofNo.of Data Wiring: Heaters Signs Ballasts No.of Devices Or Equivalent t i ..—__ No.IlydromassageBathtubs No.of Motors TotaIHTelecommunications Wiring: No.of Devices or Equina: P Equivalent `\- OTHER: W Attach additional detail ifdesireh oras required by the Inspector of Wires. Estimated Value of Electrical Work: _ (When required by municipal policy.) tWork 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 0OTHER 0 (Specify:) . I cert j,under the pains andpenalties of perjury,Mat the information on this application is true and complete. °I= 0 05140 • . (, 4, s sl' r FIRM NAME: ' - .0 . LIC.NO,: `�t� Licensee:1a MtZf) Mfly IN Signature / TIC.NO.�lS� • (ljapplicable,eni 'ex-m.t"In the licensenwfiberline.) / Bus.Tel.No.•. 76, � Address: " L '/ Jpi0 642 vat, ;moi (t me 0 b Alt Tel.No.:__-- *Per MA L.o.147,s.57-61,security wor requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: Iain aware that the Licensee does not have the liability insurance coverage normally .fequired by law. By my signature below,I hereby waive this requirement. I am the(check one ❑owner 0 ovine?s a ent. Owner/Agent PERMIT FEE:$ Signature TelephoneNo. . 60 104 • r ,. • • A The Co i `V i Fa !t mntonwealth oplassachusetis �iP 9 Department oflndustrtal 4cctdents :`-NILE 0;. l Congress Street,Suite 100 ' Boston,1114 02114-2017 • `"' www.rnass.gov/din Workers'Compensation Insurance Affidavit:General Businesses.. Ar licantInformation TO BEF.D;EDWITH TEE PERhHTTINGALTHORITY. Please Print Le ibl BusrnesstOrganizationName:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664. Are you an employer?Check thea Phone#:508.394-7778 1.[J I am a employer with aft__employe appropriate box: Business Type(required): orpart-tme).i 1es(fulland/ 5. []Retail • 2.0 Iamasole proprietor orpartnersh 6. QRestaurant/Bar/EatngEstablshmeni apacity.va no 0 • 7. Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any c 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 t.152,§1(4) and we have no employees.[No workers'comp.insurance required?* i0.0 manufacturing 4.0 We are anon profit organization • Wee non-poli ,staffed by Volunteers, 11'0 Health Care [No workers'comp,insurance req.] 12.0 Other *Aa)'applicant that checks boxes must also El out the section below showing their workers'compensation policy infoimatlon. ora corporate officers have exempted themselves,but the corporation has otheremployees,&workers'compensation policy yte required and such anarganitonshoudchebox Iamanemployerthat isprovidingworkers'compenrallontnsurance for employees. Belowlrthe olio information. Name;ARROW MUTUAL INSURANCE COMPANY Insurance Companypolicy f Insurer's Address:23 COMMONWEALTH AVE City/State/4: CHESTNUT HILL,MA 02467 • Policy#or Self-ins.Lk.#1821A ExAttach a copy of the workers'compensation policy declaration page(showing thee pol cirationDnumberate: 01/20and expiration date). Failure to secure coverage as required under Section 25A of MOL 0.152 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. Ida hereby cuff "'• owe emalltes o � fperjury that the Information provided above[s true and correct. Sty attire* !/ t 7„mei•508-394.7778 Date: 1 Official use only. Do not write he this area,to be completed by c10,or town officid • City or Town: PermitlLicense# Issuing Authority . ty(circle one): • 1.Board of Health 2.Bu1ldingDepartment 3.Cliy/TownClerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.masagov/dia •