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Home My WebLink AboutBLDE-19-006549 Commonwealth of Official Use Only , atE. , Massachusetts Permit No. BLDE-19-006549 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:5/20/2019 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 45 BOXBERRY LN Owner or Tenant DAVI a S•N.. 'INN Telephone No. Owner's Address C/O F SR, 141 R ESTEY AVE, HYANNIS, MA 02601 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: Replacement boiler&water heater. 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 ❑ In- ❑ 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 1 No.of Detection and Initiatine 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/Alertine 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 1 KW No.of No.of Data Wiring: Heaters Siens 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 //�� 0Q'' rr OifcialUse Only (,�C n'tnonweaws of aaachudetil 0 9 —(aS i-j l i_L r Th P, cc�� ((i� Permit No. epartment 0/.1 e Jervice3 '-''=1}-ek Occupancy and Fee Checked _______ ," BOARD OF FIRE PREVENTION REGULATIONS [Rey.1/071 leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),J 27 MR 2.4.., (PLEASE PRINT IN INK OR EALL_INFO.RMATION) ' Date: ) r r��' n City or Tow of:gi - e( r 1Yjt;11 1 (l @)C'`y� To the Inspector of Wires: By this application the undersi ed gives n ' e of his o her intention toier£o the electrical work described below. Location(Street&Number) (''' �-' • Owner or Tenant , `, y TelephoneNo _ 7 Owner's Address v J (.' F. --+_ Is this permit in conjunction with building permit? Yes ❑ No ❑ (Check Appropriate Box) ) Purpose ofBuilding 1t, i (•-) Utility Authorization No. Existing Service Amps ' / Volts Overhead 0 Undgrd❑ No.of Meters • C New Service Amps / Volts Overhead❑ Undgrd E No.of Meters !-C) Number of Feeders and Ampacity . Location and Nature of Proposed Electrical Work: i i eh_ ` n s"nic:J S 0 Coin letion o the ollowin table may be waived by the Ins ''actor o Wires. t� No.of Total No.of Recessed Luminaires No.of Cell:Susp.(Paddle)pans No. formesKVA No.of Luminaire Outlets No.of Hot Tubs Generators A No.of Luminaires Above In- No.of Emergency Liglttmg Swirainh Pool Bind ❑ grnd. ❑ Batter Units No.of Receptacle Outlets. No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 'No.of D and No.of Gas Burners Initiatingetection Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat ump Number Tons ••••KW-.,•.•. No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers `—� Munici al ❑ other —� Space/Area Heating KW Local❑Conner lox). No.of Dryers HeatingAppliances r ecNo.o Systems:" _-,+� Y pP No of Devices or Equivalent "i No.of Water NKWo.of No.of Data Wiring: • i Heaters Signs Ballasts No.of Devices or E uivalen t �-- 1lo.H dromassa a BathtubsTelecommunications EquivalWiring:entofNo. (�--- 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: 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 0 OTHER ❑ (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: 6r tD(tLSLr3t) pi.ttrrl- tot4 <1" fft14' i3 dt ' LIC.NO.: Licensee:I—WA-W ) M t.IJ(ft) Signature/7i • LIC.NO.:r2l S `7 , 16 (If applicable,ent "exenr t"in the license nru rber line.) Bns.Tel No.:`cG� Address: 13 iL -/Loon�l SUldfif� t(i� �1�i0 Tt-{ I/�i( fi�tf—ense: � Alt.Tel.No.:Per M.O.L.c.147,s.57-61,security work requites Departmentof PublicSafety"S" 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 am the(check one)❑owner 0 owner's a ent. Owner/Agent ck- Signature Telephone No. PLRIIIIT FEE: J�' 1 k • _ The Co nwealth of Massac1 etts Sam=�t 1)e art sr �;i�►l'ilr P merit of ;:.t: 1 Congress Street,Suite 100 ' '�`� 1. Boston,MA p2ZX�20X7 Workers' www,massgov/dia comp ensation Insurance Affidavit:General Businesses.. A Izcantlufoxmation TO BE FEUD WITH THE PERMITTING AUTHORITY. Business/Or Please Print Ise ibl ganization.Name:E.F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE GitylStatelZip SO1;TI F�'ARiv1oUTH .. ,MA 02664• Are you an employer? Phone#:508-394-7778 Check the appropriate box: ' . 1. I am a employer with Business Type(required): . or part-time).* employees(fulland/ 5. 0 Retail • 2.0 I am a sole proprietor or partnership and have no 6 [�Resfauranf/D ar/Eating Establishment • 7, 0 Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any capacity, 3.® [No workers'comp.insurance required] We are a corporation and its officers8. ❑Non-profit • their right of exemption per e, ,§have exercised 9. [[Entertainment no employees.[No '§1(4),and we have workers comp•insurance required] 10.0 Manufacturing box#1 must 4.El We are a non-profit organization,staffed by 11,[j Health Care • with no employees.[No workers'comp. volunteers, Anyappticentthatchecks msurancexeq,] 12.0 Other also fill out the section below showing their workers'compensation policy intoimation. olf 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. X am an employer that isproviding workers'compensation insurance for my employees .Blow is the policy information. Name:ARROW MUTUAL INS URANCE COMPANY Insurance Company f Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 Policy#or Self-ins.Lie,#1821A 4ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date), Expiration Date:01/01/20 f failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a :ine 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 >f up to$250,00 a day against the violator. D e advised that a copy of this statement may be forwarded to the Office of investigations of the DIA.for insurance coverage verification. •do hereby call , the s and enalties o perjury ury that the information provided above Is true and correct, i nature fa 1 f 'hone#;508-394-7778 Date: , f 1 '7/ Official use only.Do not write in this area to be completed by city or town official City or Ton: Per Issuing A uthority(circle one): mif/License# • • 1.Oohed of Health 2.Building Department 3,City/Town.-Clerk 4.Licensing Boaxd 5.SeIecfinen's Office 6.Oter Contact Person: Phone#: • www.masagov/dia