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Home My WebLink AboutBLDE-19-006036 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-19-006036 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked jRev.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:4/24/2019 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) 39 RAINBOW RD Owner or Tenant ANDREOLA JASON P TR Telephone No. Owner's Address THE EPI RLTY TRUST,45 CAMP ST, MILFORD, MA 01757 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 100 Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Upgrade service. 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 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 efrd 7/sto too A// O�cialUsa0a1Y/' n Q„Coramanweaaa 0i ma lac eud it R — = Apartmento/ }e re Serviced PermitNo. Q(1 J/U(-Qt ( ) ' Qccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 ewe blank APPLICATION F* PERMIT TO pERFORMMM ELECTRICAL WORK AU work to be performed in accordance with the Massachusetts Blect,ieal Code NEC),S2'1 12.00 PLEASE PRINT IN DX OR BALL kW IO V) Date: City or Town of: To the Inspector of fires: By this application the undersign d.gives notic f his or or'tentionfo perfo the elec rival work described below. ligation.(Street&Number (� • _��a(„ Owner or Tenant �. CC TelephoneNo. `t1) t Owagr's Address 0 S a j Is this permit in conjunctionwi`thabryddingpermit? Yes C Not[ (Cheek Appropriate Box) (� Purpose otBuilding-D 1 Ae 1 1 t nQ UJtilityAuthorizationNo. J Und d nn No.of Meters , ��_.,_ Existing Amps • ! Volts Overhead gr' u New Service Amps / Volts Overhead El Undgrd❑ No.of Meters __ .="- Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (Y} . r e Com,letion a the 'Ilowin:table may be waived by the I r o Wires. .. No.of Total No.of Recessed Luminaires No.of CeiL-Susp,(Paddle)Pans Transformers ` Generators KVA` No.of Luminaire Outlets No.of Plot Tubs No.of Luminaires g Swimmin Poo Above I- - g Z rnd. � : nd. Batter Unitsenvy g'"' _--._ No.of Receptacle Outlets. No.of Oil Burners ALARMS No.of Zones No.of Switches No.of Detection and No.of Gas Burners Initiatin_Devices No.of Ranges No.of Air Cond. Total o.of Alerting Devices }Teat Pump Number_Tons_ •,KW__ ,'No.ofSelfContained Tons No.of WasfaDisposers Totals: 'M" Detection/Alertly:Devices Hunter al ❑Other I No.ofDisliwashers Space/Area Pleating KW Local[]Connection • Security Systems:• No.of Dryers Resting Appliances KW No.of Devices orB"uivalent r^ No.of Water KW No.of No.of Data Wiring: u ) Resters Ballasts No.ofDevices orE"talent Si:'s ' into.R dromassa e BathtubsTelecommunications Wiring: " , J y g No.of Motors Total� 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.) W Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no pern it 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:) • fY— p d p fp a y, — — _, _ �erti ;under the airs and enaltc`es o �'ur _fltat`fhelnformafiora on tl2is application is mitre and coup • e e. � , Y FIRMNAM6: r tOjtUSLr�W Vtd}Ca ft"G14. 0 ' ,./tom — LW.NO: ri '— ---- -------------- I�LifYl'1 Licensee: LIC.NO.:9_1__, t i �l'l 2 V f(L1 Signature 1 (if applicable,a nit in the license nw ber line.) ' Bus.TeL No.:` 6 Address: 9r ®L��42/0 Oi 5Otti f f t( -0 a(67i� OW 0'-k Alt.Tel.No.:_—_______ *Per M.O.L.c.147,s.57-61,secuify r work requires Department of Public Safety" " License: Lio.No. s n�a11y - OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverag • _fequired by law. By my signature below,I hereby waive this requirement. I am.the(check one ❑owner 0 e`Nner's a nt Owner/Agent p�, �' r +; Signature._ Telephone Na. 1l ID'i . ACCOUNTSPAYABLE@EFWINSLOW.COM . The Commonwealth _ t wealth of g ach =: I� _Department rie setts• �_;11t� rat o.1�xndus�ialAc cidenfs G ;. M.• X Congress Street,Suite X00 • . Boston,rr4, .A 02XX4 2O17 Yoxkexs' www.lnostgoyfdia.CompensatiozrmanceAffidavit:general$nsinesses.. A Iicail$jnfoxmatzott TO13gMiD D, PR TTINGAinumunr. Business/Ozganizatzon Name:B.P.WINSLO Please Print Le ihI W PLUMBING&HEATING CO.,INC Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664, ' ire you an employer?Check the a Phone 5�✓l 3�4 777a 0 I am a employer with appropriate box: �� Business Type(required): or part time).* employees(full and/ 5. Retail ' • 0 employeesolle proprietor or partnership andha a6. workingv no ORestaurantBar/EaUngEstablishment N workers'C0 forme in any capacity, comp.insurancerequir 7' Q fRceNon -p and/or Sales(incl,real estate,auto,etc.) 0 We are a corporation and its o 8 []Non profit • their right of exem o facers e exercised no employees: rd ttperp,152,-§l(4) andwel ave 1 nmanufainment 0 [No Workers comp.insurance1D.We are a non profit organization required] Manufacturing WO no employees. ,miffed by volunteers, ILL/Health Care YaPlcanttbatchecky(,ox#imusoalsnrkers'comp,insurancereq,] 12.[j Other • temper*officers have exempted fill out the sermon below showing ' nizationshouldcheckbox#l, p�dtfiemselves,butthecozporatioahaseirworkets'compeosationpolicyinfoimation. other employees,a workers'compensation policy is required and such an 'r an employer tTtatis providing workers'compensation u'ance Company Name:ARROW MUTUAL I RNinsurancefor yemployees. Below it the policy information. rer'sAddxess:23 COMMON RANCE�COMPANY ALTH AVE • (State/Zip: CHESTNUT HILL,MA 02467 y#or Self ins.Lic,#1821A eh a copy of the workers'compensation re to secure policy declarationExpiation Date:0 I/20 coverage as required under Section 25A of page(showing the policy�p to$1,500.00p Y number and expiration and/or one-year imprisonment, MOL c.152 can lead to the imposition of criminal penalties of a to 250,00 a day as well as civil en against the violator.Be advisedthat a copypenalties in the fornr of be W0 ORDER and a fine dgations of the DIA.for insurance of this statement may be forwarded to the Office of coverage verification. ereby cent = the /'' and renalties o Penury tltattlte tnforrnation um: --- _-- provided above is true and correct. #;508=3947778 -- — -Date:- i t : • • cial use only.Do not write in tbisarea,to be completer by city or town oeiai or Town, ngAufhorlfy(circieone) Permit/License# • and ofHealfh 2,BuiTdingDe . her Pmhnent 3.Cftypy0an Clerk 4.Licensing Board 5 Sedecfinen's Office ietPerson: • Phone#: ww vm�.