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Home My WebLink AboutBlde-21-002597 • Commonwealth of Official Use Only 1� Massachusetts Permit No. BLDE-21-002597 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:11/9/2020 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 896 ROUTE 6A Owner or Tenant ARCIKOWSKI FRANCIS R TR Telephone No. Owner's Address ARCIKOWSKI MARGARET M TR, P 0 BOX 1408, DENNISPORT, MA 02639-5408 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: Replace distribution 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 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/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal ❑ 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 Q 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: $50.00 Commonwealth of Massachusetts Official Use Only Ph 1 =* i Permit No. Z- 59 i i �_ Department of Fire Services 11!-W S Occupancy and Fee Checked ' - BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05 ( �,�+ j leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR T PE ALL INFORMATION) Date: 'I /2/Z 0 City or Town of: afmWth To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street&NN�mber) V 96 Poole 6 A yarn vi-hp,7f d2d 2S` Owner or Tenant t t1Cf 5 hr tIWIAJ r f Te• •hone No. 50g3‘20/99 Owner's Address c5"L t Ll Q en/11 S Off (9,6 .3 Li ..� r. Is this permit in conjunction with a building permit? Yes ElNo EI—(Ch ck . • • , ui MT$o lc 7 Purpose of Building %\),)6 11 Utility Authorizatio N.. Ain V Existing Service Amps J / Volts Overhead ❑ Undgrd 11 No.of Mel New Service Amps / Volts Overhead ❑ Undgrd [,rr `-Nii-orA tern \_ Number of Feeders and Ampacity ��f� Location and Nature of Proposed Electrical Work: 3 0 (��/ct j - main' Brel ker ia� alp//yfi a;1 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil: p (Paddle addle F Tf Total) ans Trr anosformers KVVAA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- LiNo.of Emergency Lighting grnd. grnd. Batted Units 1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. Initiatingand 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/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local❑ Municipal ❑ Other p 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 TelecommunicationsNofDevices or Wiring: No.of Devices Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. o 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. Aq 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. �. n CHECK ONE: INSURANCE ® BOND ElOTHER El (Specify:) Sc... I cert ,under the pains and penalties of perjury,that the information on this application is true and complete. nf3 FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., IN LIC.NO.:3281C s Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (-...) rn (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)❑owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ &Ito:\ 4 au c.ummgnweattit of Massachusetts • Ar Department of Industrial Accidents _- .Ofce ofInvestigations Lafayette City Center 2st Avenue de La ette Boston PIA 021111750�f� x r • w..m• wwass.gov/din. • Workers' Compensation Insurance Affidavit: General Businesses • Applicant information Please Print Legibly Business/Organization Name: P.P. 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: Business Type(required): 1,El I am a employer with 90 employees(till and/ 5. 0 Retail or part-time).* 6, []Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. [D 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,[0 Manufacturing • no employees. [No workers' comp.insurance required]'"* 4.❑ We are a non-profit organization,staffed by volunteers, 11.0 Tlealtli Care with no employees. [No workers' comp.insurance req.] 12.0 Other *Ally 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'oompensation policy is required and such an organization should check box#1, ,l am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY TneurAr'e Adtirpsii• City/State/Zip: • • Policy#or Self-ins.Lie.#1909A 01/01/2021 Expiration Date; Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secur4•coverage as•required under§25A of MGL a. 152 can lead io the imposition of criminal penalties of a fine up to$1,500.00 antl/or one-year imprisonment, as well as civil penalties in the.£orm 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 ter' e�the Ins and penalties of perjury that the information provided above is true and correct. Signature., ^`* 1 01/02/2020 Date; Phone Ni 508-394.7778 Official use o'zly. Do not write in this area,to be completed by city or ton)n official City or Town:' Permit/License# Issuing Authority(cheek one): 1.jBoard of 1'Xealth 2.0 Building Department 3.0 City/Town Cleric 4.D),ieensing Board 5.[]Selectmdn's Office 6,[(Other Contact Pers,n: . Phone#; • www,mase.gov/dia } 1