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Home My WebLink AboutBlde-19-005813 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-005813 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•4/17/2019 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) 14 BROADCAST LN Owner or Tenant CODY MARIANNE W Telephone No. Owner's Address 64 SKATING POND RD,TRUMBULL,CT 06611-1487 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 boiler&add CO detector. 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 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 1 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 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 0 (Specify:) I certify,under the pains and penalties ofperjury,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 ft6 7 (c? P-----i` cy� cc77 (� Permit No,• V °Uepartmet o�.tire Jeroica3 and Checked ___ 41-: Occupancy _-- ..te n BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (kayo blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ' AU work to be performed in accordance withtheMassachusetts Electrical Code(MEC 527 12.00 (PLEASE PENT WINK ON WEALL JNP'Q, 0 Date: I I City or Town of: I.l To the Inspector of Wires: By this applicadontheundersignyckrmooth, ves 'ce of his or inten tic�ito p ormth electrical work described below. ocatfon(StreetNumbex) 0 • V�� /%� Owner or Tenant I j' i(�j �_ TelephoneNo. 3•z93�,' 4C Owner°s Address n 3 � f Y-�) -.-t-___Lcaza_u_ Is this permit inconjuuctionwith buil g permit? 'yes ❑ No ❑ (Check Appropriate Box) --Z--. Purpose❑£Building ' t)F ( ) r Utility Authorization.No. Fxistin Service Am Ps • / Und d No.of Meters • g p Volts Overhead❑ gr' nnit New Service Amps / Volts Overhead C Undgrd❑ No.of Meters 0 Number of Feeders and Amp acity 14oeation andNatnre of Proposed Electrical Work: a `- /• 0 6�tv ) lc C Com,letion o the ollowin:table may be waived by the InKVA a° Wires, No,of No.of Recessed Luminaires No.of Ceil.-Snsp,(Paddle)Fans Transformers Total No.of Luminaire Outlets No.of Mt Tubs Generators IYA • '0.0 mer:ency :,i 1g Above In No.of Luminaires Swimmingool :and.- -0_ and._❑ $atfex Units . No.of Receptacle Outlets. No.of Oil Burners FIRE ALARMS No.of Zones No.of Detection and • No.of Switches No.of Gas Burners. Initialing Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tans !No,of Self Contained . No.of Waste Disposers Rest Pump Number Tons _•, ._,,.. DetectionlAlexfin:Devices Totals: Municippal• ❑®�� No.of Dishwashers • Space/Area heating Ii W Local❑Connection ecurity Systems is No.of Dryers Heating Appliances KW No.of Devices orF1uivalent No.of WaterKW o.of No.of Data Wiring: Si��s heaters Ballasts No.of Devices orEtuivalent No.B:ydromassageBathtabsTelecommunications Wiring: No.of Motors Total HP No..o off Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the_Inspector of Wires. I Estimated Value of Electrical Work: (When required by municipal policy.) C.— Work to Start: Inspections to be requested in accordance withMECRule10 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 a_ undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. • CHECK ONE: INSURANCE le BOND 0 OTHER 0 (Specify:) • lieation is true and complete._ _--_ _- erh;fy,under the pains and penattres of per,jury,_that the_ttaforn�afion outfits'app FIRM NAME:SC* 0finU,SLr�a1 QGua'{'1 tot❑ • 4.ti.4' t`-t Licensee: lC Z ) t a t t iv 1t! Signature 7, LC'NO.:a�1 ' (If applicable,ent " m t"In the license nua ber line.J '�— i Bus.Tel.No.: ,68' Address: 1i 1L1�42IO(Fa 500-4 f.lb'Tir Art ek.'_ Alt.Tel.No.:---_ *Per M.G.L.0.147,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 au nit • _required by law.By my signature below,I hereby waive this requirement. I am the(check one ❑owner ❑ ) Owner/Agent p�'RjlgjT +£ 1:$ Cr Signature. Telephone No. 1�� 4 • . ACCOUNTSPAYABLE@EFWINSLOW.COM • • .Tle Co iorwealth of1f sacl e j' department ofxndustriaLlecidenis155 4" er ifi X Congress'Street,Suite X00_11 f Boston,.( p2XX42OX7e ` Workers'Comp ensafiownww.massgovidia A Heart TO BE Eb �Insurance Affidavit:Cettexal$usinesses.. Tnformatzo>z RTEE PARISI:MINGA- ORITX, Please Print Le 'hl busine me ss/Orgauizatxou Fa :E.P.WINSLo W PLUMBING&FIWfNG CO.,INC • Address:8 REARDON CIRCLE~ City/State/Zip:SOUTH YARMOU7H . ,MA 02664. ire you an employer?Check the a Phone ;5Q8 394 7778 •0 I am a employer appropriate box: part-time).* with employees(full and/ Business Type(required): •1or3. C]Retail r am a sole proprietor or QlZestauranf/Bar/EatingEstablishment employeeswor ' partuexshipand have no 6 g for in anycapacity. 0 0 [No Workers'comp.insurancerequhed) 7. C1 ffice and/or Sales(fuel,real estate,auto,etc.) We are a corporation and its o 8 [[Non profit their right of exemption per c.l52 rs have exercised -o p ,§1(4) and walleye i manni El fainmeng 0 no employees.(No Workers'comp.insurance We are a non-profit organizations required?� •1D'�Manufacturing • with no employees,lNo Workers'cold by volunteers, 11•Q Health Care • YaPPB°ant that cheeks box#1n,ust also fill out �p �Cer�'� 12.gOther secti o�6eoashow�gtheirworken'compensation y infoi o cn.ers haw emP themselves,but corporation has other employees,aw°rkers compensationpolicy i s required and such anoizton should chkbox#I 'zan employer Mat is providing workers'compensation Insurance for fry employ AL INSURANCE COMPANY ees Below is Me policy information. rer'sAddress:23 COMMONALTH AVE 'State/Zip: CHESTNUT HILL,MA 02467 • y#or Self ins.Lie.#1821A h a copy of the workers'compensation • to securepy coverage policy declaration page(showing Date:b er01/20 mg as required under Section 25A ofg�e policy numb e and and expiration date), p to ere.c0 and/or one-year dunde as MGL c. imprisonment well as c' 152 can lead to the imposition of criminal penalties a a to 50.00 a day against the violator.Be civil penalties in the form,of a STOP WORK ORDER igafions of the DTA for insurance advised that a COpY of this statement may be forwarded to the Office of and a fine coverage veri$caVon. ereby eerti . Me and enalties o 'um y perjurythattlre information provided above is free and correct.— D er � � j— a# 394=178 vial use only.Do notwrite i12 thisarea,to be co or ToledbYcifyor ,noc wn: • .l�� ngAufhority(circle one): Permit/License# axd of Health 2.Buildingbe . her Puent 3.City/Town Ciexk 4.LicensingEom d 5.Selectmen's Office tetPerson: • Rhone*