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Home My WebLink AboutBlde-20-001747 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-001747 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:10/1/2019 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) 58 STRATFORD LN Owner or Tenant MATTHEWS DORIS TR Telephone No. Owner's Address THE DORIS MARY MATTHEWS 2009 REV TRUST, 58 STRATFORD LN,YARMOUTH PORT, MA 02675 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 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 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 0 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 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 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 r pprr M� Comarwnwealth o f//lamachueattd Official Use Only 1' 't c� [� Permit No. 2c5—((7 (f1 • _ �1 2epartnten.t of Dire Serviced I j ' Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) �rG`-jil� ® T TO ® WORK FOR PERMIT PERFORM ELECTRICAL ®l ORK 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: 09/24/2019 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) 58 STRATFORD LANE YARMOUTH PORT Owner or Tenant MATTH E WS, DORIS Telephone No. 508.362.6152 Owner's Address Is this permit hi conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building RES Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd D No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: WIRE ELECTRIC WATFR HEATFJR Completion of the following table may be waived by the Inspector of Wires. otal No.of Recessed Luminaires No.of Ceil.-Sus .(Paddle)Fans No.roof TVA P Transformers I{VA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In- Po.of Emergency Lighting grnd. and. 1,1i_tts.D,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. Tons No.of Alerting Devices Meat Pump Number lions_ _I ?V No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other A Security stems:* No.of Dryers Heating Pp liances Ky No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP 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: 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 Lq BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information o appli `on is true and complete. FIRM NAME: E F IA/i.N s�.�Ul accountspa�lab� in w ca LIC.NO.:'Z/7 . 2'i7 m /I� �� Licensee: R lO4'1 2, 7i1 h 4. der it' Signature � LIC.NO.: (Ifapplicable enter"exempt"in the license number line) Bus.Tel.No.•501 3 FY 7778- Address: r` R�*.rt b eu' C IIcLt_ S.)4�I1rt.e u77J 7fi9 D a 6 4 c/ Alt.TeL No.: *Per M.G.L.c.147,s.57-61,security work requites Department of Public Safety"S"License: Lic.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)0 owner 0 owner's agent. Owner/Agent I PERMIT FEE: $ 50.00 I Signature Telephone No. WORK ORDER 512446 , 4 The:Commbrnwealth.o iti s.a iseuts- y` ,,•.: i t'-Oi `Yntlusd+ t, ern 1 Cun ss 94.aitte,100 1 Aaiun,MA 021144.017 . ` www ma4ss gov/lia Workei Compensation InsuranceAft+tdavih Builideri/Contr ct lectricians/PPtitibe .. TO Z FIL ltiE Y ;1ilt9ET AUTHORITY.. Antsl asnl *tion - Please nt � Name U t :ERF.'WINSLOW LUMBIN &HEATIN O.. INC sf lllRCl„i •'_ &QYTH•YaStool H.. i32f 5D8=494-7 78 ��,�E� s :PITUTLE�w , taa►Aboir. i J_-am.semp With _.employees(full and/or part-time)' 7. < 0-stew construction p 6eeh►and have.no emptoyeses workin m g fora`in 8 []Remo idling; an (N y o ducat comp insurance trgnired l e% antwltoii v;i$r,:doi, tt:workmyselt.P4ts> s' t i 9 0Demolition osmtp,.iisurarmet�tiire8tj 10• Bluildit 'additions �i-" to li{**vi+t4r a0i i+tt11 'p 1 xg8'or contractors i°cO conduct l tiit rk iiiy,propor4+. twill D g` caltth-104aantorceitherhave workers comp lion insurance;or are.stle 11 icart r_ ton • trt wi6no 0 rs • 12 Ptutnbtn rsorsdd tions" • 5J l cop f dthesub-oontraatoorlintedtnt;theattached<shs . • ]•3: f ctf . sits i ese t ethave eb plft 'atinil have workers'cal iai agate iricei# L p 6 earc+40-tobiati ;1i dit,o . exercisedthei htof�exe itm$10 c. 14.00iteF �F .nd we haven m1ployem.:(No wu cer' comp Insurancelegelteill 1 i i wilt � ors below showing-hei r woilcete leatyon p slte t omwtietu ` davistiii heating#hey are doing all work and hanitte tentee contraclpss,rto st sebmittegnew, "issfenneitsuch- 4C n lors rt a iition l sheet'showving th i o conixeetoit state'whe or not tenth have L • lama ploys -wor ers'co.� on-.insurance.or r t .. 5? 1' .r:.. Belarrs :heporrcy atetfbll.st ttsfo radoin. � ,�0WRO 1,MUTUAL:INSURANCE'COMPANY Policy .Lie.#1,'t909A.. __ Expiration<Datcsol1a1'120 # 0.... .. . .. . Job 4 ' . ..Cy/:Ststel-Zip. . Attach a-cop t4 t l ation:policy declarration page(shorringthe policy nuarlser and expiration j. Failure,to'st are coverage as.required u1140at L c.ISZ:425Alst criminal violation punishable by a fiiteup x 1,500:0)• and/or.one-year imprisonment,::;as well as•civil,penalties in the fort of;a STOP WORK-ORDER and a fiat tif a to$250.00 a day ore viblator.A afthis=:statement may be forwarded'to_the Office wf In±estigations.of Ave l)IA for insurance l l�i• :.1_Y ri-(iYrr 'ilR _IT77�+ ` .�l. l't. i jury at o iiv.� pro ' i ; '� o ls'true 'correct 1r or Do not turtle 44-e rea,to be completed by cky or sown of ciaL: City.or`Town:. Permit/License *Wilt Asut o�:�i�'e one): 143(iiO l tlt 2..Btuii ingDepartment 3.City/Towii Clerk 4.Electrical lnsspettor 5 Pluiabing:Inspector • b:;Other Giu at Irson - Phone#: •