BLDE-22-002846 Commonwealth of Official Use Only
i-`' ! ' Massachusetts Permit No. BLDE-22-002846
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:11/17/2021
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) 17 STATION AVE
Owner or Tenant Julie Shigekuni Telephone No.
Owner's Address
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: Install 2 heat pumps&add sub panel.
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. .TTootal No.of Alerting Devices
n
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
Totals: 2 Detection/Alertine 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 Ballasts Data Wiring:
Heaters Slots 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: 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
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Commonwealth of Massachusetts Official Use Only
1-=7---lei +i Permit No. ZZ-- (p
all _y Department of Fire Services —
I ( = 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: 11/9/21
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)17 STATION AVE, S.YARMOUTH
Owner or Tenant JULIE SHIGEKUNI Telephone No. 9177714531
Owner's Address 365 BRIDGE STREET,APT 13G,BROOKLYN NY 11201
0 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box)
Purpose of Building DWELLING Utility Authorization No.
Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
y New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters
tr)Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: (2)HEAT PUMP SYSTEMS 4^ SJ(j(;)Gctn.•Q.,k
Completion of the following table may be waived by the Inspector of Wires.
"� No.of Recessed Luminaires No.of Ceil.-Sp (Paddle le F Tanf KVATota) ans Trransformers KVA
No.of Luminaire Outlets No.of Hot Tubs Generators KVA
M No.of Luminaires Swimmin Pool Above In- No.01 Emergency Lighting
g grnd. ❑ grnd. ❑ Battery Units
(I) 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
g Tons No.of Alerting Devices
No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained
p Totals: Detection/Alerting Devices
No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑Other
Connection
No.of Dryers Heating Appliances KW Sec No riof DeviSystesees 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 TelecommunicationsNo fDeiceor Wiring:
__ No.of Devices 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 ❑ (Specify:)
I certify,under the pains and penalties of perjury,that the information on this ap lication is true and complete
FIRM NAME: E.F.WINSLOW PLUMBING &HEATING CO. 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)Downer n owner's agent.
Owner/Agent PERMIT FEE: $
Signature Telephone No.
E.F. Winslow Inspection Department email : inspections@efwinslow.com