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Home My WebLink AboutBLDE-19-003501 r, Commonwealth of Official Use Only . or ';r1,LIP% Massachusetts Permit No. BLDE-19-003501 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:12/10/2018 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) 65 AVON RD 7fa(-qz. _-33& Owner or Tenant KINNALLY JOSEPH F JR Telephone No. Owner's Address KINNALLY M C C A&P M, 16 FRONT STREET, HULL, MA 02045 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 furnace 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 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 ❑ (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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 214-11 Kg- +�- 31('1 ogSg (Let (en- �/ Offjcy4 Use Only Commonwealth.o� addac ett2 (,L '?j�,(9 k p"-_fit=Et cc�yy�� cc77 C� Permit No. •t_11 ✓ �d-1= 2epartment o/..tire Jeruked N G Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS Rey.1/07 . �� [ j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PR1VT IN-INKORTUEALL FORMATION) Date: � ' `1 / 14 City or Town of: yaproiJ .j To the Inspector of Wires: • By this application the undersigned,gives notice o i or herintention to perform the electrical work described below. Location(Street&N tuber) 6 I�ven I Q/}h olll'�n a1, 9 O d-G S • Owner or Tenant Je p ` 1 Telephone No.s<�$NQ�899 Owners Address I t; {I`- 1 y Is this permit in conju Iv tion with a building permit? Yes _ No (Check Appropriate Box) Purpose of Building 1( AV ALUtility Authorization-NO. Existing Service Amps •-' / Volts Overhead E Undgrd 0 No.of Meters • New Service Amps / Volts Overhead___ Undgrd= No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: . j(p\C&C e 1 I l tk�o n • Completion of the following table may be waived by the Inspector o Wires. • otal No.of Recessed Luminaires No. No.of Ceil:Susp.(Paddle)Fans Transformers sformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Above In- No.ofEmergency Lighting Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners 1FI E ALARMS No.of Zones and • No.of Switches No.of Gas Burners No.of Detection Initiating Devices _ No.of Ranges No.of Air Cond. Total No.of AIerting Devices No.of Waste Disposers tPu m Totp Number Tons Tsns Hea I KW No.of Self-Contained ..•...•. Detection/Alerting Devices Municipal Other No.ofDisliwashers Space/Area Heating KW Local El Connection ❑ No.of Dryers Heating Appliances f KW SecuNroSystems:* 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 corWiring:q l No.of Devices 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 [1 BOND ❑ OTHER El (Specify:) • I certify,under the pains and penalties of perjury,that the information on this'application is true and complete. M 0— FIRMNAME: ' Ci)fO6L3141 Pt-tta"/IJirv(s e'"' fte*12tt? 6P,.ha: ' LIC.NO.: _j (- , M < Licensee: C ?tL/) Nl 2,,i,ur(L) Signature j�,,l(z0 — LIC.NO.:9I S:2`7 _ �.6 U'' (If applicable,wi "exem t"in the license number line) v � Bus.Tel.No.: 0- 9Lj'77-7 �• . •i Address: I g. 0Dtv Gil if t 5vatf/ &t II4o it-stir UhG O y4/ Alt.Tel.No.: OA *Per M.G.L.c.147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. `— v OWNER'S INSURANCE WAIVER: I ant aware that the Licensee does not have the liability insurance coverage normally _ 0 required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent • Signature Telephone No. I PERMIT FEE:$ j The Commonwealth ofMassachusefts ==-Ri= Departmenttil- of XndustrialAccidents � _ 1 Congress Street,Suite 100 ' 0 5' . Boston, www.massgov/dia Workers'Compensation Insurance Affidavit:General Businesses.. TO BE FILED WITH TIE PERMITTING ATJTHOEJTY A licant Information Please Print Le ibZ • Business/Organization Name:E.E.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 a — 1. I am a employer with appropriate box: Business Type(required): . or part time).* employees(full and/ 5. 0 Retail 2.El 1am a sole proprietor or partnership 6estauranfBar/Eating Establishment employees working for me in any capaclt have n° • 7. 0 Office and/or Sales(incl.real estate,auto,etc.) 3.0 [No workers'comp.insurance required] We are a corporation and its officers have exercised 9. 0 Non-profit • their right of exemption per c.152,§1(4),and we have i Manufacturingufainment 4.❑ no employees.[No workers'comp.insurance required]* 1D'Q We are a non-profit organization,staffed by volunteers, 11❑Health Care with no employees.[No workers'comp.insurance req.] 12.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. "lithe a tion should officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. X 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.#t 821A ExpirationAttach a copy of the workers'compensation policy declaration page(showing the poIzcynumberate: 0 and 0expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a tine 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi , the a' s and enalties o perjury that the information provided above is true and correct. • Si nature: 1-x ' 1 11 Date: 1 /5/ /'/(17 Phone#:508-394-7778 , Official use only. Do not write in this area,to be completed by city or town official. City or Town: Issuing Authority(circle one): • Permif/License# I.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