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Home My WebLink AboutBlde-21-001651 co ti. Commonwealth of Official Use Only 't` 1 Massachusetts Permit No. BLDE-21-001651 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'10/1/2020 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) 10 JANNOR WAY Owner or Tenant KORBEL EDWARD G Telephone No. 1/ Owner's Address KORBEL MURIEL D, 10 JANNOR WAY,WEST YARMOUTH, MA 02673 6 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appr ..ri: 1.5 Purpose of Building Utility Authorization No. Q 2/ Existing Service Amps Volts Overhead 0 Undgrd 0 , I rl- New Service Amps Volts Overhead 0 Undgrd 0 No.o r ' F Number of Feeders and Ampacity -4 r,Location and Nature of Proposed Electrical Work: Install generator. 84, O P Completion of the following table may be waived by the Insp rtli es. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 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 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 Siens 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) 0 owner 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT $50.00 ----Fat:1\04 t 1 (-42,0 • A Commonwealth of Massachusetts ftrclal Use On ' *= �/ iti(, y Department of Fire Services Permit No. - (p�( �,''' BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Pee Checked • [Rev.9/OS] (leave blank -------- ) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Iviassaohusetts Electrical Code (ME527 (PLEASE PRINT IN.IA/K OR TYPEAI,L tNFOPJ A9 Date:TJG I�•-D CMR 12.00 City Town of: fiMO Aro �l/Z2 By this application the undersigned gives notice of his or her intention to perform t e tr cal the Inspector w k described below. Location(Street&Number) ' An W •- 0 2-6 7 Owner or Tenant Of Owner's Address 'I'Y1 Telephone No. 3�/‘ Is this permit in conjunctikan Ili a building permit? Yes ❑ No Purpose of Building 'i•1 (Ghetto AptaroprfA#a9x) Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New- S— et v _ice Amps / Volts Overhead Number of Feeders and Ampacity 0 Undgrd❑ No.of Meters Location and Nature of Proposed Electrical Work: a /n,5- / • Co 4-noir , th- •Bowl :table ,I be alved b the Ins•eotor. tares. No.of Recessed Luminaires No.of Cell.-Susp. (Paddle)Trans o.b KVa A No,of Luminait'e Outlets Transformers No.of Hot Tubs Generators ' • KVA No.of Luminaires Swimming Pool ; eve n- `o.o 'm;rgency :ag No.of Receptacle Outlets �.r.td. ❑ �rnd. ❑ Bette Units No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners `o.o eteo on an No.of Ranges Iriidi:Un_Devices NO.of Air Cond, • o a N Tons No.of Alerting Devices No.of Waste Disposers eat 'ump ` ens Totals: o.o e - onto ne, No.of Dishwashers �� Detection/A ertin. Devices Space/Area Heating KW Local Tun a pa ti No.of Dryers Heating Appliances ecu ❑Connection ❑Other `o.o „a :r KW ' ystems: Heaters KW `o•o .O.o No.of Dev ca.or E•ulvalent Q • Sims Ballasts Data Wiring:f r No.Hydromassage Bathtubs No.of Motors �, No,of Devices or : ; valent v .ota2li�F , e No ofDe a cilia. tr:ngg: OTHER: No. Devices or E.uivalent Attadh addtttonal detail desired,or as required by the•inspector of Wires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) Inspections to be requested.in accordance with MEC Rule 10,and upon completion. INSURANCE COVE GE: 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 e �, M undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office, lJ" CHECK ONE: equivalent. The INSURANCE ra BOND ❑ OTHER ❑ (Speoi I certi y,under the pains and penalties o.,Pe ') I {Jury,•that ir{Jormatton on this a licatlon Is true and complete.(� PRIM NAME; E.F.WINSLOW PLUMBING&HEATINQ CO., i CM ! - Licensee: RICHARD MELVIN LIC.NO.:3281 C (N.1 t` _ atappltcable,enter"exempt"to the license numbwline.) Signature LIC.NO.i 21829A �/J Address: s REARDON CIRCLE SOUTH YARMOUTH,MA 02804 Bus.Tel.No. b0s•894.777s b-u *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S S INSURANCE WAIVER: IeAlt.TeL No.: required by law. By my signature below,am ereby waive this requ rsae equirement.1 am the(check ont have the e ownercove age normally Owner/Agent Signatureowner's a eat. Telephone No. EIEPJ,fITFEE'$ /az1 • • 6 • • The Commonwealth of Massachusetts Department of In4ustrial Accidents e� .Office of Investigations� 1111= Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02X11-1 7S0 • www.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: Business Type(required): 1.1:::] I am a employer with 90 employees (full and/ 5• ❑Retail or part-time).* n 2.Q I am a sole proprietor or partnership and have no 6' `�Restaurant/Bar/Eating Establishment employees working for me in any capacity. 7. ❑Office and/or Sales(incl.real estate,auto,etc.) [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑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.[]Health Care with no employees. [No workers' comp.insurance req.] 12.0 Other *Any 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. 1 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.#1909A Expiration Date:01/01/2021 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 anti/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 cer • ' er the ins and penalties of perjury that the information provided above is true and correct. ignattire: �«.�.�..r.. 01/02/2020 _Date: Phone#; 508-394-7778 Official use oily. Do not write in this area,to be completed by city or town afflciat City or Town: Permit/License# Issuing Authority(check one): 1.OBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.0Licensing Board 5.0 Selectmen's Office 6.DOtiier Contact Person: . Phone#: www.mass.gov/dia •