The URL can be used to link to this page

Home My WebLink AboutBLDE-19-005047 fit/ Commonwealth of official Use only it Massachusetts Permit No. BLDE-19-005047 til\, • . ''*�®` 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:3/7/2019 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) 13 CEDAR ST Owner or Tenant MACPHERSON RICHARD R Telephone No. Owner's Address MACPHERSON JAYNE,3 WEBSTER ST, NATICK, MA 01760-5927 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 and add CO detector. 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 1 Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 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 p474 `ilzlrC elaS 7( ((gk 41- i/4/5 Commo am nwealth Only l,ommonwealth o/Massac`.. netts �- i R Permit No. - • =�lidl=a cc�� c7 2epartment al ire Services _i=. Occupancy and Fee Checked • 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 C),527 IR 12.00 (PLEASE PRINT IN INK OR T. E ALL INFQRMATIO.N) Date: I I City or Town of: Cif'y- T r\ r---;Ou 1`- ` To the Inspector of Wires: By this application the undersign d gives noise of�or her intentionP perform the electrical work described below. . lineation(Street&Number) I, cl+ . Owner or Tenant r' U , P`. Telephone No. 75,76 Owith'sAddress — J , / k_n, LC 1 I— C, - O J Is this permit in conjunction with a building permit? Yes_ Purpose of Building `�(L {' I �'�(; Utility Authorization No. :—L Existing Service Amps ' / 1No _ (Check Appropriate Box) Volts Overhead 0 Undgrd III No.of Meters f ^ New Service Amps / Volts Overhead❑ Undgrd C. No.of Meters t ) Number of Feeders and Ampacity Location and Nature of Pro osed El ctrical Work: • � C tc"�(1 fir► yen wtnc fable ma be waived by the Inspector oYfu es. • Completion of the folio Y sect No.of Recessed Luminaires No.of � Total ' No.o£Cei1:Susp.(Paddle)Fans Transformers �A No.of Luminaire Outlets No.of Hot Tubs Generators `'' No.of Emergency Lighting No.of Luminaires SwimmingPool Aplld e ❑ • grnd ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners SIRE ALARMS No.of Zones No.of Switches No. of De Detection aonttnd • No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of AIerting Devices No.of Waste Disposers Heat Pump Number.Tons._._.KW..._..,_. No.of S if Contained : es Totals: ' Municipal Other No.of Dishwashers Space/Area Heating IOW Local❑ Connections — Security Systems No.of Dryers Heating Appliances KW No.of Devices or Equivalen t No.of Water KW No.of No.of Data Wiring: Heaters Ballasts No.of Devices or Equivalent Signs Telecommunications Wiring. No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalen t �/'�" 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.) i 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 Cam•- undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE u{ BOND ❑ OTHER 0 (Specify:) • I certify,under the pains and penalties of perjury,that the information on this application Is true and complete. FIRM NAME: � t4�lt1) Lon PGtc l`3toIS 4- f[s/'4` Plo 60,dif -`- , ' LIC.NO.: �j?`U�1 L Licensee:i2t awn f 1 Gt-W(IU Si nature st.� — LIC.NO.:_l__7__ (If applicablet,7enter z-VOP cl(?mod `Jl 014 tiiik7tLIDLtfii-lr 01 O-6 Alt.TeI.No.: *Per M.G.L.0.147,s.57-61,security worl 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)D owner ❑owner's agent. Owner/Agent K(� c° Signature Telephone No. PERM2T • ��--_ o, f 1)#. 1e ACCOUNTSPAYABLE@EFWINSLOW.COM • • The Commonwealth ofMassaclauseits ft I)e art P meat o wig .f'IndustrialAccidents 0,1111W = 1 Congress Street,Suite 100 ' V` Boston, p2XX4 20X7 www.mcrssgov/dia Workers'compensation Insurance Affidavit:General FII Businesses.. A Head Information TO BE ED WITS THE PERMITTING AUTHORITY. Business/Or Please Print Ise 'bI ganization Name:E. F.WINSLOW PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664, • Are you an employer?Check the a Phone#:508-394-7778 1. I am a employer with appropriate box: Business Type(required): . or part-time).* employees(funand/ 5. Retail • 2•El I am a sole proprietor or partnership6 [� estauiantBar/Ba`ung Establishment employees working forme in any capacity.have no 7. []Office and/or Sales(incl,real estate,[No workers'comp.insurance required] 8. ❑Non-profit auto,etc.) 3.0 We are a corporation and its officers have exercised 9. 0 Entertainment • their right of exemption per c.152,§1(4),and we have no employees.[No workers'comp.insurance required] ; 0'� 11• manufacturing 4. We are a non-profit organization staffed by volunteers ❑Health Care El 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#I. 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.Lie.#1821A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date. Expiration Date:01/01/28 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 foam 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, X do hereby certi the a' • and enalttes o perjury that the information provided above is true and correct.Si nature: • ? t-�. phone#:508-394-7778 Date: r • 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.BnildingDepartment 3.�t ' 6.Other Y�own Clerk 4.Licensing Board S.Selectmen's Office Contact Person: Phone#: • www.masagov/dia