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Home My WebLink AboutBLDE-22-002475 d4., Commonwealth of Official Use Only it1 Massachusetts Permit No. BLDE-22-002475 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/N INK OR TYPE ALL INFORMATION) Date:10/30/2021 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) 11 CROSBY ST Owner or Tenant Larry Pincus Telephone No. Owner's Address 11 CROSBY ST, SOUTH YARMOUTH, MA 02664 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&water heater. C pletion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Padd an No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool A o In- No.of Emergency Lighting gr ; grnd. Battery Units No.of Receptacle Outlets No. f Oil Burners FIRE ALARMS No.of Zones No.of Switches i 1�1 of Gas Burners 1 No.of Detection and Initiatine Devices No.of Ranges .o Air-Cond. oval / No.of Alerting Devices No.of Waste Disposers at Pump Numb Tons W No.of Self-Contained tale: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW ❑ Municipal 0 Other: k7.,),ocal Connection No.of Dryers Heating Appliances K Security Systems:* No.of Devices or Equivalent No.of Water 1 Kw No.of .of Ba a g Data Wiring: Heaters Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total H� Telecommunications Wiring: No.of Devices or Eauivalent 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 perjuty,that the information on this application is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 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 my 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 Commonwealth of Massachusetts FOfficial Use Only 7 s �I= � 1 S t Permit No. t✓22�2"1c ( „I- 7" Department of Fire Services 11=s Occupancy and Fee Checked �� ,� BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] (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: 10/19/2021 City or Town of: YARMOUTH(SOUTH) To the Inspector of Wires: QBy this application the undersigned gives notice of his or her intention to perform the electrical work described below. u ) Location(Street&Number)11 CROSBY ST. 103- Owner or Tenant LARRY PINCUS Telephone No. 6176454282 Owner's Address SAME Is this permit in conjunction with a building permit? Yes El No El (Check Appropriate Box) t^ — Purpose of Building UtilityAuthorization No. Existing Service Amps / Volts Overhead 0 Undgrd El No.of Meters �" New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters U.1 Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: BOILER/WATER HEATER Completion of the following table may be waived by the Inspector of Wires. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.ofKVA 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 00 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. Tons No.of Alerting Devices I4 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices A'". No.of Dishwashers Space/Area HeatingKW Local Municipal ❑Other P ❑Connection No.of'Dryers Heating Appliances KW Security Systems:* rY No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent -No-H dromassa Bathtubs No.of Motors Total HP TelecommunicationsNofDeiDevices or Equivalent QO Y ge No.of Devices Equivalent i` OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. iPir 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 0 OTHER ❑ (Specify:) . I certify,under the pains and penalties ofperJury,that the information on this ap licatlon is true and complete. FIRM NAME: E.F. WINSLOW PLUMBING &HEATING CO., I LIC.NO.:3281C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: 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)El owner n owner's agent. Owner/Agent I PERMIT FEE: $ Signature Telephone No. E.F.Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts a Department of Industrial Accidents • • 9_—=,t-,,.,,,,, Office of Investigations 1, ==t = Lafayette City Center Cs�_ `= 2 Avenue de Lafayette, Boston, MA 02111-1750* �•'' wwx.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: 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: I I Business Type(required): 1.❑■ I am a employer with 90 employees (full and/ 5. 0 Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.1=1 Other *My 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#1. 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: City/State/Zip: Policy#or Self-ins. Lic. #1964A Expiration Date:01/01/2022 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under § 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 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce • the ins/and penalties of perjury that the information provided above is true and correct Signature: ).-//` -'!'--- Date: 01/02/2021 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(check one): 1.❑Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia