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Home My WebLink Aboutblde-20-000776 Commonwealth of Official Use Only Permit No. BLDE-20-000776 Massachusetts 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:8/12/2019 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) 728 ROUTE 28 Owner or Tenant PIRATES COVE EAST INC Telephone No. Owner's Address 728 ROUTE 28, SOUTH YARMOUTH, MA 02664-5158 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 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 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/Alertine 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:$80.00 gp)4 7C(I �n/ A Commoruvea o /l'lamactucietfa Bidet Use only "' , ='i PermifNo. __I ;a. Permit of Jive—cervical 41 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. (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 PRINT IN INK OR TYPE ALL INFORMATION) Date: 08/05/2019 City or Town of: SOUTH 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) 728 MAIN STREET- GOLF COURSE Owner or Tenant PIRATES COVES Telephone No.508.394.5252 Owner's Address SAME Is this permit in conjunction with a building permit? Yes ❑ No 0 (Check Appropriate Box) Purpose of Building DWELING Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ELECTRIC W/H-30 GALLON Completion of the followin table may be waived by the Inspector of Wires. oNo.of Recessed Luminaires No.of Ceil.-Sus .(Paddle)Fans r ns of Total p Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting grnd. nd. Batte Units No.of Receptacle Outlets No.of Oil Burners ERIE ALARMS No.of Zones oNo.of Switches No.of Gas Burners No. Initiatingon nDete and Devices Tota No.of Ranges No.of Air Cond. Tons No.of Alerting Devices HeatFump Number_.Tons 1 W. No.ofSelf-Contained Totals: ing No.of Waste Disposers I """""'" Detection/Alert Devices No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other P Connection No.of Dryers Heating Appliances KW ecurity stems:* Y _ No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters 1 KW Signs Ballasts No.of Devices or Equivalent •No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications qulvi Y g 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: 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 [ "BOND ❑ OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information�t�tyls appli tion is true and complete. FIRM NAME: E T j/�/t i.,r/5 Ld a / LIC.NO.:2% ' . 9'i Licensee: RIe,01, ' 7j�4 10.ii! Signature x/ LIC.NO.:/j174 74 (If applicable enter"exempt"in the license number line) Bus.Tel.No.•5L>?' 35''V 777,$' Address: '" Ra iz a cia C Mr LE: S.yogi"'yip,o ti7 h' 2041 a c 6 i '( Alt.Tel.No.: 'Per M.G.L.c.147,s.57-61,security work requires Department of/Public Safety"S"L.icense: Lic.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)0 owner 0 owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. EMAIL:ACCOUNTSPAYABLE@EFWINSLOW.COM ,/7 WORK ORDER #506018/ PERMIT FEE-$50.00 IV�1 t The Commonwealth of Massachusetts —71=' Department of Industrial Accidents 1 Congress Street,Suite 100 `!= Boston,MA 02114-2017 wwwntass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):E.F.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 appropriate box: Type of project(required): 1.0 Tam a employer witt-i 88- - -employees 7. 0 New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] 8. []Remodeling CT am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on myproperty. 10❑Building addition ensure that all contractors either have workers'compensation insurance or I will are sole 1 l.[]Electrical repairs or additions proprietors with no employees. 5.0 lam a general contractor and I have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance? I..❑Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Policy#or Self-ins.Lie.#:1909A Expiration Date:01/01/2020 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$i,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and=•r e pap s nd pen ties of perjury that the information provided above is true and correct Si.4 a e: --, Date: Phone#:508-394-7778 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.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: