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Home My WebLink AboutE-19-3030 Commonwealth of Official Use Only kw"- Massachusetts Permit No. BLDE-19-003030 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked --^ JRev.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:11/16/2018 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) 1 TOURAINE WAY Owner or Tenant LOWE LOIS J Telephone No. Owner's Address 1 TOURAINE WAY,SOUTH YARMOUTH, MA 02664-1957 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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: Servicer ins. j tj6 (`- 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- a 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 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 KW No.of No.of Data Wiring: Heaters Stens 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 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 8lk el2 0yA ? ham, ee' q�� f 0} rislUse Only • Commonwea& o//rlaooacfufsetfd .1.-j Q-3 ,p3 Q • )a ei cc;� cc77 n�r Permit No. ` e 2,epartmentol, ireJerukes occupancy andFeaChecked__ ___ . `ego' BOARD OF FIRE PREVENTION REGULATIONS •ev.1/07] eaveblank • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with lheMessachusetts Electrical Code(MEC),S21 CMR 12.00 (PLEASE PRINT BlINK OR •'ALL INF aRMATIOR) Date: )1 J 10 i L Q City or Town of: ' , Mi , To the Inspector of Wires: By this application he undersigne. gives notice of hisI-'or her intention to perform the electrical work described below. . Ixreation(Street&Number) ,,, ,jnj W ., • OW i-t-, 0'16(.4 Owner or Tenant LOS Lat,e Telephone No.SOR�.5a16_0_153?A Owner's Addr ess , Is this permit in conjunction with a blinding permit? Yes 0 No ed (Check Appropriate Box) Purpose of Building by.)01"l� UtilityAuthorizationNo. Existing Service_ Amps / Volts Overhead CI Undgrd❑ No.of Meters New Service _ Amps / Volts Overhead Undgrd❑ No.of Meters _____ Numhbr of Feeders and Ampacity Location and Nature of Proposed Electrical Work: W, 0 ''e Seigler • Completion ofthefollowingtablleo.o bewatve• db thelTut l ro Wires. - No.ofRecesse• dLuminaIres No.ofCeil-Susp.(Paddle)Fans Transformers ICVA KVA No.of Luminaire Outlets No.of Hot Tubs Generators — Above In- 'No.ofergency Lighting No.of Luminaires SwlmmingWeolmnd ❑ mnd 0 �m Batiery___s____ _Id. _ No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and • No.of Switches No.of Gas Burners Initiatin Devices • No,of Ranges No.of Air Cond. Total Tons No.of Alerting Devices Heat Pum Number Tans No.of sel-Contained No.ofWasteDisposers p -•• Detection/AlertmgPevices Totals: Municipal Other No.ofDtslwashers Spece/AreaHeatngBW Local KW Security Systems:" No.of Dryers Heating Appliances KW No ofDevicesorEquivalent_ No.of Water No.of No.of Data Wiring: Heaters Signa Ballasts No.of Devices Or Equivalent • Telecommunications Wiring: No.IlydromassageBathtubs No.of Motors Total HP No.of Devices orH,uivalent OTHER: Attach additional detail ifdesire4 oras 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 MECRule 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. •-•-.0 7CHECK ONE: INSURANCE It BOND 0 OTHER ❑ (Specify:) e7 c1�\-n • I cerab,under the pains and penalties of perjury,that the information on this application Is true and complete. C `' FIRMNAME: -c U) NSLou' •L up, (y d. �'p ,,' - r ' LIG.NO.: _'�I_ IS' '1— Licensee(%t C f/() M WhiN Signature LIC.NO.:ol�l S�`��f 1/4�P '� (fapplicable,a,6r"esem.t"Inthelicenenwberine) Bus.Tel.No.•�6 0 W 0 Address: - L'.!I IMO ftat5alt ;.t boa I-( got 0 4‘.`t Alt.Tel.No.:—_---- gc *Per M.O.L.o.147,s.57-61,security wor requires Department of Public Safety"S"License: Lio.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 0 owner 0 owner's a ent Owner/Agent PERMIT FZtg;$ . Signature Telephone No. c 0 iu 4 • I • A i t The Commonwealth of llfassacltuseuus . a=Sti iceirt"f .Department oflndustrtal4ccidents °, ,�� 2Congress Street,Suite 10O • - � — Boston,1124 02114-2017 • Workers' • www.massgov/dta Compensation Insurance Affidavit:General$us nesses.. • A„licantTnformalio n TO MBPI=NSTIlf THE R ERMITTINGAUTHORTM Please Print Le.ibl Business/Organization Nate:E.F.N1INSLOW PLUMBING&HEATING CO.,INC ' Address:8 REARDON CIRCLE City/5tate/Z]p;SOUTH YARMOUTH,MA 02664. phone#:508-394-7778 • Are you an employer?Check the appropriate box: 1.[]J Iamaemployerwth'f(} Business 0RType(require d): or part-time).* 1_0____.employees(full and/ 5. Retail • 2.0 1 am a sole proprietor or partnership and have no 6. ORestaurant/Bar/EatingEstablishment • 7. 0 Office and/or Sales(St real estate,auto,etc.) employees working for me in any capacity. 3.0 [No workers'comp,insurance required] We are a corporation and its officers have exercised 8. 0 Non-profit • their right of exemption per t.152,§I4 9. 0manutacturint ( ) and we have no employees.[No workers'comp.insurance required* 10'0 manufacturing ng 4,�] We are a non-profit organization,staffed by volunteers, I1.0 Health Cara • • with no employees.[No workers'comp.insurance • Any apPlirantthat checks box ill must also fill out the .] 12.0 Other . tit Are,a poryo t to officers have ill exempted themselves,ofillot section below showing theuworkers'caworkeatieripolicy infoimolicy comomtionhas other employees,aworkers'compensation policy is required and such an a/n an employer that s-providing royiding worker3 co isuranceCompanyNameARROWMUTUALINgUationiyruratceforntyemployees Below rsthe policy information. INSURANCE COMPANY surer's Address;23 COMMONWEALTH AVE ty/State/Zip; CHESTNUT HILL,MA 02467 bey#or Self-ins.Lin#1821A 47 tack a copy of the workers'compensat on alit 01/01/20 dedaratonpage(showingtirepolrcDflu' benndepfrtj0 date). lure to secure coverage as required under Section 25A ofMGL c,152 can lead to the imposition of criminal penalties of a 3 up to$1,500.00 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ip to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. hereby cerci the.¢� ' �9rs and/enauteg o PerJury plat t/se inforrnaflon provided a6ave Is and correct iafure• ., h.� 1 • e;;608-394-7778 Date: - • '7 • 1 • walleye only. Do not write in this area,to be completed 6y city or town official • ty or Town: Wag Authority(circleone): Permif/License# BoardofHealth 2.$nddthg De )they partment3.CityfTownCierk 4.I,IcensingBoard S.Selectmen's Office rtsctPerson: Phone#: • www.mass.gor/die . i