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Home My WebLink AboutBlde-18-005640 - /. Commonwealth of Official Use Only V ILA Massachusetts Permit No. BLDE-18-005640 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:4/9/2018 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) 31 SOUTH ST Owner or Tenant JOHNSON CARL H Telephone No. Owner's Address 554 ROUTE 28, HARWICH PORT, MA 02646-1858 Is this permit in conjunction with a building permit? Yes 0 No 0 ( k • • • • . • Box) Purpose of Building Utility Authorization Existing Service Amps Volts Overhead 0 Undgrd ❑ ,". oil' • ,s-- New Service Amps Volts Overhead 0 Undgrd ❑ e •At)) s Number of Feeders and Ampacity �C�f�dV��f� ,r, Location and Nature of Proposed Electrical Work: Install ge - -. • ,y f Completion of the following table may be wai n pector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of O 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. Batten/Units No.of Receptacle Outlets 1 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 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 ev4)47--(por pc c l—) 74Li/t e Official Use OnlyV � Commonweal A ol a3dackuIIetts j 8 �� ►k--- si c� Permit No. L L t.t-mii_ 2epartment o� ire Serviced - Occupancy and Fee Checked _— °N --- ) BOARD OF FIRE PREVENTION REGULATIONS ,• crt� [Rev.1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ,527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) 6 Date: 4 // City or Town of: 2J 1Ou r (So/ 14)To the Inspector of Wires: By this application the undersigned�gives notice of his or her intentionfo perform the electrical work described below. Location(Street&Number) Cf - %%f .5%(2_ e // L 50:�� Owner or Tenant C��L ,54;7 Telephone No. e , Owner's Address G' R 1 c)lG / 414 Z 6 41S Is this permit in conjunction with a building permit? Yes ❑ No n (Check Appropriate Box) Purpose of Building /3 k- _Lt// ' 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: /15 i &e /4)��fGu-97-I� l Completion of the following table may be waived by the Inspector of Wires. • No.of Total ).) No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA (\- , No.of Luminaire Outlets No.of Hot Tubs Generators KVA C Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Batte 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 Initiating Devices No.of Ranges No.of Air Cond. To s No.of Alerting Devices VJ No.of Waste Disposers Heat Pump(Number'.Tons IKW No.of Self-Contained Totals:I Detection/Alerting Devices Municipal ether No.of Dishwashers Space/Area Heating KW 'Local❑ Connection ❑ lf\ HeatingAppliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: 1 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 0. 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: gr ottosCoW Plat14-- Pic. 6" ftS/4-12P Q, 116 • LIC.NO.: 3,,T6 i[- Licensee: t ckz_n Pt tW U1(U Signature fie,e _ LIC.NO.:91 g2` ' • (If applicable,ent exem t"in the license nw fiber line) Bus.TeL No.:5G�'-3 gy'.?7 18. Address: tick LION Gi(ecle 5orzl -f 4 lA�/Yt,a-r t Aft 0LI'6,, Alt.Tel.No.: *Per M.G.L.c.147,s.57-61,security world requires 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 ❑owner's agent. Owner/Agent I PERMIT FEE:$ 0 (7 0' p Signature Telehone No. .. The Commonwealth of Massachusetts ; V Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY.Aaulicant Information Please Print Legibly Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO., INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664• Phone#:508-394-7778 Are you an employer?Check the appropriate box: 1.0 I am a employer with ® Business Type(required): ��employees(full and/ 5. ❑Retail or part-time).* 2.El I am a sole proprietor or partnership and have no 6. ❑Restaurant/Bar/Eating Establishment 7.8. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 3.❑ [No workers'comp.insurance required] 8. Non-profit We are a corporation and its officers have exercised 9. ❑Entertainment • their right of exemption per c. 152,§1(4),and we have 4.❑ no employees.[No workers'comp.insurance required]** 10.0 Manufacturing We are a non-profit organization,staffed by volunteers, MD Health Care with no employees.[No workers'comp,insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If 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#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address:23 COMMONWEALTH AVE City/State/Zip: CHESTNUT HILL,MA 02467 Policy#or Self-ins.Lic.#1821 A Expiration 1/2 Attach a copy of the workers'compensation policy declaration page(showing the policy u berte: 0and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. • I do hereby cerli , the a' s and enalties o perjury that the information provided above is true and correct. ff11/ Si nature: •�. -�-4. � �� • ��`.:'� Date: Phone#:508-394-7778 • ' Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia F' � TOWN OFYARMOUTH y o R BUILDING DEPARTMENT 1146 Route 28, South Yarmouth, MA 02664 `e Ate^ },E= Y 508-398-2231 ext. 1263 Fax 508-398-0836 K. Elliott, Inspector of Wires kelliottnvarmouth.ma.us July 24, 2018 Richard Melvin E. F. Winslow Plumbing & Heating 8 Reardon Circle South Yarmouth, MA 02664 RE: Carl Johnson,31 South Street, So Yarmouth Permit Number: BLDE-18-005640 Dear Rich; The above noted location inspection failed to pass for the reason(s) listed. Article 210-12(A) Arc fault circuit breaker required. Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained, to the property, for the re-anspedion. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth, Building Department K. Elliott, Inspector of Wires