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Home My WebLink Aboutblde-19-002406 _ Commonwealth of Official Use Only E` Massachusetts Permit No. BLDE-19-002406 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:10/23/2018 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) 20 ALDEN RD :o. X � Owner or Tenant KRETSCHMER MATTHIAS W Te i0h!' Owner's Address BARADARAN KHANDAN,9 HASTINGS RD,WESTON, MA 02493 ` 4 y Is this permit in conjunction with a building permit? Yes 0 No 0 (Che - • • ' l • Purpose of Building Utility Authorization No. / 8 ... /‘? ,.; Existing Service Amps Volts Overhead 0 Undgrd 0 No.o •New Service Amps Volts Overhead 0 Undgrd 0 No.of Mete O Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install ductless A/C, 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. 1 Tons Tot No.of Alerting Devices 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 4-1-(19 ti ,4c' er„,,4 3�13 `� � Sb9_7'rt-ast lP Act4,1i 14 34G4C 4- 14) o7— ZZ7- 5-322 CO J�t,S nn rr 0 cialUse Only Commonwealth.o� a��ochu6etf� (� t e -- Y j.o !I, cc� C� PermitNo, \ `L —\ �F ebePartmen o� ire Jeruiced it.I Occupancy and Fee Checked__ *. ,,4, BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leave blank) • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance with the Massachusetts Electrical Code(77M27 C 1 0 (PLEASE PRINT IN.lNK OR T EALNORMATIOI) C�V( City or Town.of: ( To the Inspector of Wires: By this application the undersigned giv s no e of his or h it e tion t perform the electrical-work de,Eribed below. IJdc i ation(Street&Numb r) 0 € t Tin Q A 1 I Owner or Tenant +{r{, -tie Telephone No. Ownbr's Address CI Is this permit in conjunction with11 a bu ding permit? Yes L No "i� tEheck Appropriate Box) ()Minding Purpose uilding D V W e 1 Utility Authorization No. Existing Service Amps / Volts Overhead E Undgrd C No.of Meters New Service Amps / VoIts Overhead_ Undgrd= No.of Meters Number of Feeders and Ampacity t Locatio and�`Ia;re of Psopose3 Ele trical Work: V V j h, MAI 74 a • l f�fn— ' f .� 4 r A _ A ►1 �j • ' L, Coin.letion old ollowin:table ins be waived b the Ins sector o 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 No.of Luminaires Above In- •No.of Emergency Lighting SwimmingPool grnd. grnd. ❑ Battery 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. Total No.of Alerting Devices HeatToI Number'Tons IKW No.of Self-Contained No.of Waste DisposersPump .. I Detection/Alerting DevicesOei Totals: No.of Dishwashers Local❑Monet Space/Area Heating KW Connection HeatingAppliances KW Security Systems: No.of Dryers PP No of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KWBallasts No of Devices or Equivalent Signs No.II dromassa e Bathtubs Telecommunications Wiring: y g No.of Motors Total HP No.of Devices or Equivalent • OTHER: r" 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. +r INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless ,J ,,, �1 the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The �p undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. T CHECK ONE: INSURANCE II BOND ❑ OTHER 0 (Specify:) —� I certify,under the pains and penalties of perjury,that the information on this application is true and complete. _1_. �— ) FIRM NAME: 5- t?�(fl) LrSo Pau, .0 4y -I C . LIC.NO.: `�j s`a 4oc I�Yli�tr (o ��ii-F'�� f. l ice' : Licensee:��,1Ca-Can /14 G��tf� Signature %� L-•�`'�--` LIC.NO.x__�� (If applicable,entgg�� exeni t in the license number line) ti �' Bus.TeL No,:`iGg-.3 Address: ii 9L`L//il7/U(t(ttt wwiitf4 GIIQ'�/I Dit-rt4,Art (jyb� Alt.Tel.No.: 'Ter M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lie.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 ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. c11 /) 6 • The Commonwealth of Massachusetts 17.---leara_iii Department of IndustrialAceidents 1 Congress Street,Suite 100 Boston, 111 p2XX4-20X7 • www.mass.gov/dict - " v. Workers'compensation Insurance Affidavit:General Businesses..TO BE FILED WITH THE PERMITTING AUTHORITY. " A licant Information f Please Print Ise ibl Business/Organization Name:E. F.WINSLOW PLUMBING&HEATING CO INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOU T H MA 02664. Phone#:508-394-7778 Are you an employer?Check the a • ppropriate box: Business Type(required): • 1.�✓ I am a errlployer with employees(full and/" 5 Retail or part-time).* • 2•E] I am a sole proprietor or partnership and have no 6. CResfaurant/Bar/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 officers have exercised . 0 Non-profit • their right of exemption per c.152 9. ®Entertainment no employees.[No workers'comp.in§1s4r'and required?*e we have 1p[�Manufacturing 4.❑ We are a non-profit organization,staffed by voluntee s,with no employees. ILO Health Care [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. **Ifthe 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 Blow 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.Lk#1821A Eiration Date:Attach a copy of the workers'compensation policy declaration page(showing the policy number0and0expiation 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 certi the axis and enalties o perjury I er ury that the information provided above is true and correct. Si afore; �1 508-394-7778 2 . Date: %a- i3 '�` Phone#: Official use only. Do not write in this area,to be completed by city or town officiate • I City or Town: Issuing Authority(circle one): Permit/License# • 1.Board of Health 2.Buiidin 6.Other gDepartment 3.City/Town Clerk 4.Licensing Board 5.SeIectmen's Office Contact Person: Phone#: www.mass•gov/dia