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Home My WebLink AboutBLDE-22-001287 �. -'l\\ Commonwealth of Official Use Only E Massachusetts Permit No. BLDE-22-001287 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:9/6/2021 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) 2218 HEATHERWOOD Owner or Tenant Anne Armington Telephone No. Owner's Address 2218 HEATHERWOOD,YARMOUTH PORT, MA 02675 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 furnace. 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. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners 1 No.of Detection and Initiative 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 0 Municipal ❑ Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Euuivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Euuivalent 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) ❑ owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 J1,4 (ct ) l/q( teE commonwealth of ill ,9srachusetts Official Use Only Willa kermit No. Z' (*ow Department of Fire Services v1ii Oaoupancy and Pee Checked ?�'-= BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05l (leave blank) APPLICATION FOR PERIVIIT TO PER ORNI ELECTRICAL WORK All work to be performed la accordance-with the Massachusetts)3leotrieal Code(MEC),527 CMR 12.00 (PLEASE.PRINTIN.INK OR TYPE ALL IN.P'OPI 1TION) Date: q/3 a It City or Town of: `6/1140414 To the.Inspector of Wires: By this application the undersigned gives notice ofhis or her intention to perform the electrical work described below, Location(Street&Number);Za,I g 1.1 uj - 1 R 02 67 5 Owner or Tenant kine (i,/•ll/l on �4n `o� S ��' �rtXiMbu,f� ��o C4— Telephone No, 5Qg%?•3�U y Owner's Address / Is this p erxnit in conjunct'on with a building permit? Yes I I No LJ (Check.Appropriate Box) Purpose of Building ,i�.,uv In io Utility Authorization No. . Existing Service Amps . / Volts Overhead❑ �Indgrd.n No.of Meters New Service Axnps / Volts Overhead L Y7ndgrd I I No,of Meters Number of Feeders and Amps city Lo cation and Nature of Pop used Electrical'Work: ieff4 c f r2 5,1`(-/.i0 n Completion of the followin•table may be waived by the Inspector of Wires, No.of Recessed Luminaires No.of Ceil,�-Burp.(Paddle)Fans No.of Total Transformers KVA No,ofLuzn Moir e Outlets No.of Hot Tubs • Generators XVVVA No,of Luminaires Swimming Beal grmd,a I I grnd. II Battery Uni No.of ts No.of Receptacle Outlets No.of Oil Burners EIRE ALARMS No.of Zones No,of Switches • Na.of Gas Burners No.of Detection and Initiating Devices Total No.of Ranges No,ofM).-Cond. Tons No.of AlertingDevices No.of Waste Disp osers IdeatBuxnp Number Tons KW No.of Self Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local r Muninnecticipalon Other • Co No.of Dryers IIeatingAppliances KW ,Secttrity'S steps:'‘‘ No,of Water No,of Devices or Aguzvalent No, of No, of Beaters KW Data Wiring; Signs Ballasts No.of Devices or Equivalent No,Hydromassage Bathtubs No.of Motors Total l31' Telecommunications W iring No.of Devices or Equivalent OTIIX♦B: Attach additional detail IT desired,,or as required by the Xnspeotor of Wires, Estimated Value of Electrical Work: (When required bymunloipal policy,) Work to Start; Inspections to be requested in accordance with C Rule 10,and-upon completion. INSURANCE COVERAGE; Unless waived by the owner,no permit for the performance of electrical work may issue unless the license e provides proof of liability insurance including"completed operation"coverage or ifs 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 ❑ OTHER ❑ (Specify;) Ni \ I cat*,wader ate pains and perualties ofpery'zuy,That the information on this ap ligation is true and comptete. S )31.I1.l NAME; E C-lF. WINSLOW PLUMBING &HEATING CO„ I LZC NO, 32810 C Licensee; RICHARD M VIN Signature _ • LIC,NO,:2`l 829A of applicable,enter"exempt"in the license number line) s '! e Address; s REAROON CIRCLE SOUTH YARMOUTH,MA egee4 Bps.Tel.No,: Alt.TeL No,; N *Security System Contractor License required for this wont;if applicable,enter the license number here: �. OWNER'S INSURANCE WAIVER; I am aware that the Licensee does not hare the liability insurance coverage normally required bylaw, By my signature below,I hereby waive this requirement. I am the(check one)0 owner Downer's agent, Owner/Agent • _ i Signature Telephone No, 1.P `,R IT IRE: $ E,F, Winslow Inspection Department email: inspectionsQefwinslow.corn The Commonwealth of Massachusetts 'r. Department of IndustrialAccidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette,Boston,M4 02M-1750 •r'°" www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/OrgariizationNaroe: 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: Business Type(required): 1. ni I a-rn a employer with 90 employees (full and/ 5. []Retail or part-time).* 6. Lf Restaurant/Bar/Eating Establishment 2.i I I am a sole proprietor orpaztuership and have no 7. Office and/or Sales (incl.real cs ._,�LL[o,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. Non-profit 3.I I We are a corporation and its officers have exercised. 9. ❑Entertainment their right of exemption per c. 152, §l(4),and we have 10•[]Manufacturing no employees. [No workers' comp. insurance required?* 11.0 health Care 4.n We are a non-profit organization, staffed by volunteers, . with no employees. [No workers' comp.insurance req.] 12.0 Other . *Any applicantthat 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. X am an employer that is providing workers'compensation insurancefor my employees. Below is the policy information. Insurance CoznpanyName:ARROW MUTUAL INSURANCE COMPANY Insurer's Address: City/State/Zip: Policy#or Self ins.Lie.#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 p1,500.0-0 an-or x one-year iniprisonment, as well as civil penalties lathe fo.uu of a S'1 U.l'WORK ORDE1and 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 ever yr fro le.the ins and penalties of perjury that the ilzfoi-mationprovided above is true and correct. 01/02/2021Si8 Sig-nature: Date: , Phone 4: 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): 1.0E oard of Health 2E(Building Department 3.0 City/Town Clerk 4.[Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.inass,gov/dia