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Home My WebLink AboutBLDE-19-006128 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-006128 fL 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:4/30/2019 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) 300 BUCK ISLAND RD UNIT 3E Owner or Tenant MEYERS BURT R Telephone No. Owner's Address MEYERS KARIN R, 159 BROADWAY, HASTINGS ON HUDSON, NY 10706-2904 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 ❑ 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 condenser 1#.3-E) 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 Initiatine Devices No.of Ranges No.of Air Cond. 1 Total 2 No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alertine 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 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 ofperjury,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 c 7/3(/ /� A I OfficialUse Only l orrtmanwealth o/ adeachuddf6 it- =. c•y� �7 Permit No. = 1=. Permit of ire SePDICS3 • .= Qccupancy andEee Checked • BOARD OF FIRE PREVENTION REGULATIONS ev.1107] cave blank LP • APPLICATION Fs R PERMIT TO PERFORM ELECTRICAL WORK • All work to be performed in accordance withiheMassachusetts Electrical Code(MEC,527 12.00 (PLEASE PRIlV1`IN.lNKO1 TIT EALLLW 0 Date: 25 n City or Tow oft ( , ' To the Inspector of Wires: By this application the undersi ed gives notice f lc nr her intentlo o erform the elecbl' al work described below. L;dcation(Street&Number) Owner or Tenant X e TelephoneNo. 5 O�7 �7 �/ Owngr's Address Q 1 S Is this permit in conjunction with i building permit? Yes ❑ o ❑ (CheckAppropxiat ox) v Purpose of Building Utility Authorization No. Und d No.of IVleters _____ .��. Existing Service Amps /3 Volts Overhead 0 gx ❑ Zr-' New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters __ Numbs r of Feeders anti Ampach y A r Location and Nature of Proposed Electrical Work: _ Q _ t ..._I • notion_ o , r fn n TYes Com letion o the ollowin table may be waived by wW In A No.of . - No.o£RecessedLuminaires No.of CeiL-Snsg,(Paddle)Pans Total Transformers No.of Luminaire Outlets No.of Hot Tubs GeneratorsA n O.o ergeney g g No.of Luminaires Above Swirnming}"oo1 rnd.- ---.I nd. ° Batter Units No.of Receptacle Outlets. No.of Oil Burners FIRL ALARMS No.of Zones • No,of Switches No.of Dti No.of Gas Burners• Initiatinetec Devionandces No.of Ranges No.of Aar Cond. Total No.of Alerting Devices Tons No.of Waste Dis osexs Heat Pump Number,Tons KWy.. No.of Self Contained p Totals: Detection/Alextin Devices Local❑Munich's' ❑Other No.of Dishwashers Space/Area Heating Ii W MunicConneets' No.of Dryers Heating Appliances IOW nutty Systems: No.of Devices or E uivalent No.of Water KW No.of No.of Data Wiring: �_ Heaters Sig Ballasts No.of Devices orE uivalent °J No.Hydromassa Bathtubs Telecommunication Wiring: g No.of Motors Total HP No.of Devices or E uivalent 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 re uestedinaccordancewithMECRule10,anduponcompletion. 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 le BOND ❑ OTHER ❑ (Specify:) ---------------1 —aertify;Altrier the pains and penal es ofprfjury,-that thelnfa of on this a2plication is trite and complete --- — — -- FIRM NA1VDS:S 0110Lr�ct1 Gino- La 4- f erk cf�,d1 • LrC:NO.: _ Licensee:I-,(C W1tl. ) Mt 1,1M0 Signature LSC.NO.:a`l t 5n ' (if applicable,a "exem t"In the Ilcense ma er line.) v ` Ems.Tel.No.:�----- Address: 1 A-MI GI1�5U1bfri 114Da6 t" l '€,k —Alt.TeL No.:_--_____ *Per M.O.L.c.147,s.57-61,security wor requires Department of Public Safety"S"License: Lio.No. - OWNER'S INSURANCE WAIVER: I am aware thatthe 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 CI owner ❑ovfn�'s(tont. Owner/Agent Signature Telephone No. Miff T F. E.$ i . . ACCOUNTSPAYABLE@EFWINSLOW.COM . The CO it -Dv ofMassaclar serYs 1 ' -Dva`tmenf o, Xndustxial.�tccidents �n�= � .7 coin -_ p Congress Street,Suite 100 ,` Boston,MA p2XX�°20X7 Yoxkexs'�0mpensatlwwmgovfdia oA TpRE BIM) surancaAffidavit:GenexaIBusinesses.. Read Information 'TRTH>1R�DTGATITHORTTY. usiaess/Oxganizaizon Naito: PLUMBING e.E.P.WINSLo Please Prin Leal MBING&HEATING CO.,INC address:8 REARDON CIRCLE ;ity/State/zip:SOUTH YARN1oUT ' H,MA 02664. phone#:5Q8-394- - . e you an employer?Check the a 7778 I am a employer with appropriate box: part-time).* employees(full and/ Business Type(required): . or l am a sole o 5. 0 Retail . employees proprietor x or inpart xship and have no 6 QRestamanf/Bar/BatingBsfablishmnt ' g for me in any capacity, 7. 0 Office and/or Sales(incl.real estate,auto, [No workers'comp,insurance Tequireto.) We are a corporation and its o 8. ❑Non.-profit • their re at of'exemption der c, ers e exercised no it right of'e _.-. § (4),and wa iave 9. ['Entertainment We are anon-profit yes.[ or workers'comp.insurance required*• 0 r Manufacturing • h no moloyees. organization,staffed byvolunteers,[No workers ° voln Il.[j HealtOther Care r aPPlantthat checks omP•insurance r the.co box#lmustalsofil(outthes �] 12•[1 Other rizatil should officers boo#have I1 must themselves, won below show n. es,but the corporation showing their 10 °aworkers'cornmpensation ensatfoipolicy �0�r employees, workers compensationpolicyisrequirrd and such an i an employer that is'providing workers'co INSURANCE compensation CO on insurance for my employees Delay is the policy information. Lance Comptny Name:ARROW MUTUAL RANCE COMPANY rer's Address:23 COMMONWEALTH AVE iState/Zip: CHESTNUT HILL,MA 02467 • y#or Self-ins,Lic.#1821A ch.a copy Se°i the workers'compensation sho gthepolicyn e:ber�l/2Q re to secure coverage as re ( wing the policy numb ex and expiration date), ip to�I,500.00 fined under Section and/or one-year tion 25A ofIVIGL e .152 can too$1,5 0 a dayy ar imprisonment,as well as civil penalties in the forad to m of a STOP WO imposition of rRK ORDER and a a against the violator.Be advised that a copy of this statement may be forwarded to ligation of the DTA.for insurance coverage fine ereby earth ,-;. � verification., the Office of the, and,et;altiee o ere: \__, . per ur that ' �` y the information provided above is free card correct. #t;508=3947778 -- -= bate: t 9�� - - cia1 use only.Da notwrtte in this area,to be co mpletedby city or town offickd or Town; mit/Ikons& ng Authority(circle one): Per. and ofHeaIth 2,Building . her ent 3.City/T0 Clerk 4.LicensingBoard S.Selectmen's Office • acfRerson: •