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Home My WebLink AboutBLDE-19-2464 Commonwealth of ofse;aluaeonly e Massachusetts Permit No. 6LDE-19002464 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked (Rev.1/07v.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 PRAT IN INK OR TYPE ALL INFORMATION) Date:10/25/2018 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertonn the electrical work described below. Location(Street&Number) 15 MAUSHOPS PATH Owner or Tenant JONES RICHARD C Telephone No. Owner's Address 15 MAUSHOPS PATH,WEST YARMOUTH, MA 02673 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 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 0 In- 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 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 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 ❑ (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 CR,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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 (ir Commonwealth ol„/assachuseffa Official Use Only Ai PermitNo.iTS2 ?-Vial— :s .apartment elle Services . a' Occupancy and Pee Checked ,14* BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Coc a(MEC),527 CMR 12}i.00 (PLEASE PRINT DUNK OR ' ALL i ORMATI01v7 Date: City or Town of: G 1 t To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. . LIMation(Street&Number) MAtictn1I 1 - e, Ycr(ma4 .0a.61 3 Owner or Tenant fkiCk, 1 • , TelephoneNo.rj QJ 03 6 Owaer's Address , Is this permit in conjunction with a building permit? Yes ❑ No ei (Check Appropriate Box) PurposeoYBuilding ' Owk \.\fl Utility Authorization No. Existing Service^ Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead 0 Undgrd❑ No.of Meters Numbr of Feeders and Ampacity I"IIVI�IN Finn Location and Nature of Proposed Electrical Work: 00.5 fUfhU.(G Completion of the following table ma bewaivedb theins ecoro Wires. ta No.of Recessed Luminaires No.ofCeil-Sus ,(Paddle)Fans ranf p Transformers KVA • No.of Luminaire Outlets No,of Hot Tubs Generators A _ Above La- No.of Emergency Lighting No.of Luminaires Swimming Pool , sad. 0y nd. Batter Units - - No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones • No.of Switches No.of Gas Burners No.of Detection andInitiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disosers Heat Pump Number Tons I Ne.of Self-Contained P Totals: Detection/Alertingpevices M No.of Dishwashers Space/Area Heating KW Local 0 Connecunicipation 0 Other Security Systems No.of Drers Heating Appliances KW No.of Devices orEquivalent No.of Water No.of No.of Data Wiring: Kt /� Heaters Sig s Ballasts No.of Devices or Equivalent v l No.II dromassa eBathtubs No.of Motors Total HP TelecommunicationsrEgiri al Y g No.of Devices or Equivalent —4— OTHER: . • (/1 Attach additional detail ifdesired,or as required by the Inspector of Wires. O 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 Et BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the Information on this application is true and complete. k CP FIRM NA :: ✓' kJ tO5Lo o •Gtc. , cv r gi r' i � ' LIC.NO.: Licensee: 1Cf�l�bl) /Vl tU((tI Signature LW.NO.91572?" l° (lfapplicable,ent "exem.t"hi the license number line.) � Bus.Tel.No.' K68 '� S Address: - ,I'' MP Clfat Int L r O ft b bAlt.Tel.No.:—____ Per M.O.L.0.147,s.57-61,security wor requires Department of Public Safety"S"License: Lie.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 ant the(check one)❑owner 0 owner's a nt. Owner/Agent PERMIT FEE:$ Signature Telephone No. l• • it • A t�—_�Are The Commonwealth of Massachusetts pp=;�MDepartment ofIndustrtalAccidents 6t__;4� 1 Congress Street,Suite 100 R`4 Boston,MA p2XI4--2017 • www.massgov/die Workers'Compensation Insurance Affidavit:General Businesses.. TO BE MED WITH THE P ThINGAIITHORTCY, A c a 1icant Information Please Print Letibi Business/Organization Name;E.F.WINSLOW PLUMBING&HEATING CO.,INC • Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02684. ' Are you an employer?Check thea Phone#:5083947778 L.0I am a employer with �(�appropriate box: Business Type(required): orpart-tine).+ `�-employees(fuiland/ 5. ❑Rete! . • 2.0 Iamasole proprietor orpartnersh P and have 6. QRestauranf/Baz/BatingEstablishment employees won ' no king for me in any capacity, 7. 0 Office and/or Sales(incl.real estate,auto,etc.) [No workers'comp.insurance required] -profit 3.[] We are a corporation and its officers have exercised 8. Nonrtainm • their right of exemption per c.152, l4 9. ❑M Manufacturing no employees.No workers'comp.insurance eq have 1to Health are ng 4.[� We azo a non-profit organization, taffed rlun volunteers, 11.[]Health Cara with no employees. by volunteers, No workers comp.insurance req.] 12.0 Other *Any applicantthat checks box must also fill out the section below showing/heirworkers'compensation policy infoimation. **lithe corporate officers have exempted themselves. organization should check box C. but tha corporation has atheremployees, aworkers'compensetionpolicy is required and such an I con an employer that is providing workers'compensation insurance for my employees. Below is Use policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COM ANY Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02487 • Policy ii or Self-ins.Lie.#1821A EAttach a copy of the workers'compensationpolicydeclarationpage (showing t epolicirationynumber0and��ationdate). Failure to secure coverage as required under Section 25A ofMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Cent , • • ! ena�tles o perjury that the Information provided above is true and correct. 4 .....m a Date: - - I / 'hone ..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(circle0ne); Permit/License# • 1.Board ofHealth 2.Building Department 3,Citynbwr.Clerk 4.Licensing Board 5.Selectmen's Office .Other ContactPerson: Mone#: wwwnrass.gov/die