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Home My WebLink AboutBLDE-19-006414 r i'(l f p+^� Commonwealth of Official Use Only ._,,.1 I ig) Q'� Massachusetts Permit No. BLDE-19-006414 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/N INK OR TYPE ALL INFORMATION) Date:5/13/2019 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 desc 'bed below. Location(Street&Number) 155 SEAVIEW AVE 6. 17" 023-- 4 0q 9 Owner or Tenant RILEY PETER J Telephone No. Owner's Address RILEY ABBEY J, 17 WHITE PLACE, BROOKLINE, MA 02146 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&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 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 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 -/zfc' /e -2c $/ /i 1 ////s� II OfficialU 0 � ' CorrtmonweaGth o��addochu6eifd ('"�l kt _= t c7 Permit No. • i b 2epar nt o� }ire Serviced • occupancy and Fee Checked__________ra - -- BOARD OF FIRE PREVENTION REGULATIONS ev,1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code(4,C),527 oMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL 1NFQ1 4TION) ' Date: City or Town of: j r(yrh To the Inspector of fires: • By this application the undersign gives notice is or her intentio perform the electrical work described below. Location(Street&Number) (f' " / ' 'e- j • Owner or Tenant Telephone No, +()t�' t 9 Owner's Address (' i n C Yr) Is this permit in conjunction with a building permit? Yes _, No [ (Check Appropriate Box) (.`•,;) Purpose of Building ' 1 F Utility Authorization No. Existing Service • Amps • / ' Volts Overhead❑ Ilndgrd❑ No.of Meters New Service Amps / Volts Overhead E. Undgrd E No.of Meters __ Numbbr of Feeders and AmpacityAK I£�,1 Location and Nature of Proposed Electrical Work: MEV A 1 Id rnts. _ Com�letiono the ollowin:table may bewaveddyrnein w�res. No.of No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)r+ans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators TVA Above In" : `o.o mergeneyLzg' ug No.of Luminaires SwimmingPool rnd. _rnd. Batter Units No.of Receptacle Outlets. No.of Oil Burners ALARMS No.of zones 4-No.of Detection and • No.of Switches No.of Gas Burners XnitiatingDev.des No,of Ranges No.of Air Cond. Total No.of Alerting DevicesTons HeatTotals: l Number Tons.. H`f_.,., No.of Self-Contained No.ofWasteDisposersp I,.....--- - - •. --. Detection/AlextingDevices r r Municipal Other No.of Dishwashers Space/Area Heating KW Local❑ Connectzott ❑ • Security Systems: No.of Dryers Bleating Appliances KW No.of Devices or E•uivalent No.of Water I No.of No.of Data Wiring: Heaters Si:ns Ballasts No'moo of Devices or E�uivalent No.,..c•-:)-- H dxomassa e Bathtubs Telecommunications Wiring: y g No.of Motors Total HP No.o£D evices or Equivalent i OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Ca_ Estimated Value of Electrical Work: , (When required by municipal policy.) Work to Start: Inspections to be requested in accordancewith 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 i1 BOND ❑ OTHER 0 (Specify:) • - - •- _Icertify,under the pains and penalties of perjury,_that the information on this application is true and complete. FIRM NAME: c to .)6Lrial PP?toffs 4. ifG14'`1P, t3 �fp,.(i�- Licensee: jCT(Lj)�G�J U Signature�y` �-� LTC.NO.:c2' (If applicable,entg�"ex"eni�":in the license u tber line.) -` Bus.Tel.No.: 6�--- Address: / ,1L��f'/ 41/U �l SU/+fif� tjiQ�/14Dt(WI- AO' OL6�`r .Alt.Tel.No.: *Per M.G.L.o.147,s.57-61,security worl 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 normally • _iequired by law. By my signature below,I hereby waive this requirement. I am the(check one)0 owner ❑owner's a ent. Owner/Agent P& �* : 50 cc' signature_ Telephone No. )b 11): • le . ACCOUNTSPAYABLE@EFWINSLOW.COM . • • The Commonwealth o f e ar 11�Iassacl�usetts i _Department of lndustrialAcaidents =�'ri = -. X Congress Suite 100 ' Boston,MA Q2114 20.17 Workers'compensation www.massgovidia compens tion Insurance Affidavit:General Businesses.. A. Head TO BE WZTH THE PE Information RMITTINGAUTHORITY, Business/Organization E .P Please Print Legibly ame: WINSLOW PLUMBING&HEATING CO.,INC Address:88 REARDON CIRCLE City/State/Zip:SOUTH yARMoU T • H, •MA 02664. ire you an employer?Check the a Phone#;508-394-7778 •ElI am a employer with��j ppxopxiate box: Business Type(required): or part-time).* —�employees(full S. Retail • U X am a sole proprietor or partnership6. Q1Zesfaur ant/Bar/Baring Establishment employees working for me in any and have no ❑ [No workers'comp.insurance capacity, 7. 0 Office and/or Sales(incl,real estate,auto,etc.) We are a corporation.and i required] 8, ffcers have exercised ❑Non-profit • their right of exemption per c,152,§14 9. [�Entertainment no emplhtof No workers'comp. O'and we have I.❑ We are a non-profit or p insurance required] . 10. 0 Q Manufacturing • ' withe noe anprof employees.organization,staffed by volunteers, [No workers'coinsurance ILL-1 Health Care nyapplicantthatchecks comp.insurancereq.] I2.[j Other . box must also fill out the section below showing their workers'compensation policy infoimatien. 1f the.corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation Ifthe.cm should check box#1. xm an employer that is providing policy is required and such an g workers'compensation insurance A my employees Below is the policy information. surance r that y Name:ARROW MUTUAL pens INSURANCE COMPANY :urer's Address:23 COMMONWEALTH AVE !y/State/Zip: CHESTNUT HILL,MA 02467 (icy#or Self-ins.Lie.#1821A tack a copy of the workers,compensation policy declaxationpage(showingflpepotIzcyon Date: 01/24 numbe%r expiration daie), hire to secure coverage as required under Section 25A of 3 upit to$ecure co00 and/or one-yearrequired d unimpder Section as MGL c.152 ie can lead form.o the ofa STOP ofW criminal p ER ens of ia welt as opy pen isti to e the bea STOP WORK ORDER of aline tp to 250.00 a day against the violator. Be advised that a copy of this statement may o• estigations of the DEA for insurance coverage verification. forwarded to the Office of hereby cent , • aifisand enaltieso iatuxe, , perjury that the information provided above is true and correct. 508� c .t1 /'i - - re#:" 394=7778 ,a,,,.-- Date: Tidal only. city or town offieiab ty or Town: tiling Authority(circlo one): Permit/License# Board oPHealth 2.Building Depa Department 3.City/Toy,,nClerk 4.Licensin Boar Other . g d 5.SeIecfinen's Office • ntactPerson: • Phone#: • Www.massgovkdia