HomeMy WebLinkAboutBLDG-15-001461 Commonwealth of Massachusetts Official� Use Only
Permit No. /2 2.Z I�
Department of Fire Services
•=-�=f_ Occupancy and Fee Checked
' BOARD OF FIRE PREVENTION REGULATIONS
�•��.,cs`' [Rev.9/05] (leave blank)
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:04/25/2022
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)15 BRUSH HILL RD, YARMOUTHPORT, MA 02675
Owner or Tenant JOHN HILTON Telephone No.
Owner's Address 240 CEDAR RIDGE DR, GLASTONBURY, CT 06033
Is this permit in conjunction with a building permit? Yes ❑ No ❑✓ (Check Appropriate Box)
Purpose of Building DWELLING Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: SINGLE HEAT PUMP SYSTEM FOR THE FAMILY ROOM
Completion of the following table may be waived by the Inspector of Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Tf T
Transformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators 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
of
No.of Switches No.of Gas Burners No. Initiatinnggon Dete and
In 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: 1 2 Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local El Municipal 0 Other
Connection
No.of Dryers Heating Appliances KW Secu of yDevices 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 NofDeieor qu Wiring:
No.of Devices Equivalent
OTHER:
5960 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: 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 D OTHER ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this ap lication is true and complete.
FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO.dI LIC.NO.:3281C
Licensee: RICHARD MELVIN Signature LIC.NO.:21829A
(If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778
Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.No.:
*Security System Contractor License required for this work;if applicable,enter the license number here:
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)❑owner n owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
E.F. Winslow Inspection Department email : inspections@efwinslow.com
-=� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FII I ING WORK
CITY' XigniX71( MA
Oths
OF:SrfE ADDRESS- /S /7L Uc`Yl 141 I I /alA OWNER'S E '�/� G- PI LY�I F lit+ "t"--04,61
G OWNER ADDRESS: F,fNP TEL' FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL$
PRENT2
17 RA-RIX NEW7gr RENOVATION:❑ REPLACEMENT:❑ PIANS SUBMI I I til: YES❑ NO❑
APPLIANCES? FLOOR Bsmt 1 1 2 1 3 1 4 5 5 7 1 8 1 9 1 10 11 12 I 13 1 14
BOILER I I I I I
BOOSTER I I 1 I I I I
I CONVERSION BURNER I I I I
COOK STOVE I I 1
DIRECT VENT HEATER
DRYER
FIREPLACE /
FRYOLATOR
FURNACE - I I
GENERATOR j I
GRILLE
INFRARED HEATER I I
I LABORATORY COCK I I
MAKEUP AIR UNIT I I
OVEN I
POOL HEATER I '
I ROOM/SPACE HEATER I I
ROOF TOP UNIT I I I
TEST 1 _ I I I I
UKTHEATER% v� t F f F: I I I I
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UI�,JEI�TED.ROOMBEATER'— }
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bu.,,,"'"'.',,,vr,"" ' INSURANCE COVERAGE
I "a ou _� foEcy or its substantial equivalent which meets the regcmemezt of MGL Ch.142 YE` NO 0
If you have checked Y6 please Indica'ai the type of coverage by checking the appropriam box below.
LIABILITY INSURANCE POLICY ® OTHERTYPE YPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE WAWER I am aware that the licensee does not have the insurance coverage required by Chapter142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNL1 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and'vlforrnaton l have submfded(or entered)ngarding this application are true and a•• - to the best of my I
Knowledge and that all plumbing work and installations periotmed under the pamul issued for this application will be in.�•<tan'-with I -;rtnent
provision of the Massachusets Stale Plumbing Code and Chapter 142 tithe General Laws.
PLUMBERIGASLIl1tkNAME: 11)4) I / /'-Pl /J/w UCENSELcol y • SIGNA1W
COMPANY NAME Qp7 n d2 &3 j� ADDRESS: 9C O S&
CITY• Ib-etzzt/i� STATE//A4 LP: 026 FAX:
o, o' VT—2593 CEIl: EMAIL
MASTER D JOURNEYMANg IP INSTALLER 0 CORPORATION 0 r PARTNERSHIP❑: LLC❑g
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