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Home My WebLink AboutBLDE-21-003582 ` 6 $ Official Use Only • / Commonwealth of Permit No. BLDE-21-003582 - Massachusetts 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:12/28/2020 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) 42 VALLEY RD Owner or Tenant MALLEGNI BRENDA L TR Telephone No. Owner's Address BLM REALTY TRUST,6 WOLFEN RD, SOUTHBOROUGH, MA 01772-1129 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 alVet Number of Feeders and Ampacity >G Location and Nature of Proposed Electrical Work: Install generator. ��C� -r O7/ Completion of the followin a •., I tiiii,tor of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of � ► al Transformers �' A No.of Luminaire Outlets No.of Hot Tubs Generators 1 VA 24 No.of Luminaires Swimming Pool Ab 0 In- ElNo.of Emergency Ligh ' g grnove d. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS o. ones q•' No.of Switches No.of Gas Burners No.of Detection nd O<(`C ' Tons Initiating Devi s. * No.of Ranges No.of Air Cond. Total No.of Alerting D iti s� � 4 ' {y'1 . ,. (8 y " No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained , (-® / Totals: Detection/Alerting Device- `,--°,. o- No.of Dishwashers Space/Area Heating KW Local ❑ Connection ❑ N0tt ,. 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 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 signature below,I hereby waive this requirement.I am the(check one) 0 owner ❑ owner's agent. Owner/Agent -1 Signature Telephone No. PERMIT F : $50.00 (.1 017 4.7„----ramot `{`� T 4 t>>),b e vert v _.�= commonwealth of Massachusetts Official Use Only -' rf- 1 Department of Fire Services Permit No. 2( 0 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( 27 CMR 12.00 (PLEASE PRINT IN INK OR PE ALL INFO T O /D(MEC), 1 S J � �\ Date: City or Town of: a f)(no( , i ��ec ( To the Inspector of Wires: By this application the undersign d gives n tics is or er tentior1'to perform the electrical work described below. Location(Street&Number) I �1Q / pf� Owner or Tenantrn C F. j r. r o p, � I Telephone No. —'� r // Owner's Address S q (1' , 7 Is this permit in conjunction with a buil ing permit? Yes n No ❑ (Check Appropriate Box) Purpose of Building J Utility Authorization No. Existing Service Amps / V Overhead ❑ Undgrd n No.of Meters New Service Amps / Volts Overhead n Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ( K� cJe(',P1)Q�O 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 0 No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners N .of DCtCLhou mid Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local El Municipal Connection ❑'Other No.of Dryers Heating Appliances KW Security Svystems _ No.of Water No.of Devices or Equivalent No.of f No.o KW Heaters Data Wiring: 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 desireg or as required by the Inspector of Wires. I 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. f'0 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 Ll I 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 thepains and penalties o perjury,that the information on this application is true and complete. P .fP J Y, FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., IN LIC.NO.: 3281C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A • (If applicable, enter "exempt"in the license number line) Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.: 508-394-7778 Alt*Security System Contractor License required for this work;if applicable,enter the license number here:No.: 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. I PERMIT FEE: $ 50,60 I Department ofi'ndustrialAceidents .Office ofinvestigations .lF =i;•l= Lafayette C1 y Center .� 2Avenue de Lpfayettea.Boston,MA 02.1111750 ,47 r�+� .• www.rnuss.gov/dta. . Workers' Compensation Insurance Affidavit: General Businesses koplicantiXnformation Please Print Leaiblv . Business/Organization Name: E.F.WINSLOW PI.UMBING&HEATING CO, INC. • Address:8 REARDON CIRCLE • • City/State/Lip:SOUTH YARMOUTH, MA 02664 Phone#:508-394,7778 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 80 employees(fltll and/ 5. .❑Retail or part-time).* 6, [J Restaurant/Bpr/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7, []Office and/or Sales Owl,real estate,auto,etc.) employees working for me in any capacity. , [No workers'comp.insurance required] 8, Ej Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per a. 152,§1(4),and we have MO Manufacturing no employees. [No workers' comp.insurance required]'"* 11, S ealtli Care 4.❑ We area non-profit organization,staffed by volunteers, with no employees. [No workers' comp.Insurance req.] 12.0 Other *My appllaant that decks box#1 mast also fill out the section below showing their workers'compensation policy informatioti, **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#l, 1 am an employer that lsproviding workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Tncnrer'e Arhre4 City/State/Zip: Policy#or Se1fLilts,Lie.#1909A . Expiration Date;01/01/2021 Attach a copy of the workers' eoznpensatioan policy declaration page(showing the policy number and expiiration date), Failure to seour4 coverage as xequired under§25A:of MGL a.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anci/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORD.ORDER and a fine of up to $250.00 a day aghinst the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insurhnce coverage'verification. X do hereby der a the/ ins and penalties of perd:ay that the In ormation provided above is true and correct, i atu e: , � " l,�.r. If..- e : 01/02/2020 $ an< r . hate, Phone#: 608.384»7778 Official use o}zly. Do not write in this area,to be completed by city or town official, City or Town:, Permit/License# issuing Authority(check ones . laBoard of health 2.1:I Building Department 3.0 City/Town Clerk 4.D icensing Board 50 Selectmon's Office 6.DOtliei- Contact 1' rs' _G 4n: . • Phone##s www.mass,gov/dla ,