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Home My WebLink AboutBLDE-21-000710 1,0 ' Commonwealth of Massachusetts Official Use Only Permit No. E 2l 671 tf ee,I Department of Fire Services f- BOARD OF FIRE PREVENTION REGULATIONS [Rev.Occupancy/05and Fee Checked ' (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 27 CMR 12.00 \ (PLEASE PRINT IN INK OR TYP ALL INFO TION) Date: 8- le!2 D City or Town of: NGti/'ai-els To the Inspector of Wires: IQ V By this application the undersigned gives notice of his or her intention to perform the electrical work described below. J Location(Street&Number) I.rj Sam_n_Sp.-- g O \( ab.W& v 2(p(o q ' Owner or Tenant e I rii tap yvh1 e✓c t Telephone No. 40 y (o/s 77 Owner's Address 'AMC C Is this permit in conjunction wit build' g permit? Yes 0 No (4164. . 'ri x Purpose of Building A(VQ'bvl VI Utility Autho !�'t��,1� Np Exicr:ng Service Amps / "Jolts Overhead❑ Un�� ,i' , , t k. Z/ New Service Amps / Volts Overhead❑ Undgrd f /. ' Number of Feeders and Ampacity � O Location and Nature of Proposed Electrical Work: E let l r ` l ''b vt ev -r 441t, rf' e Completion of the,(ollowin&table may be waived by the Inspector o ares. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Tof Traa onKVAsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires SwimmingPool Above In= No.of Emergency Lighting IP grnd. ❑ i:rnd. ❑ Battery Units CO 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 M No.of Ranges No.of Air Cond. Tons Total 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 0 Co nnectinicipionl El Other Co No.of Dryers I' Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent KW 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: I 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. k\J):r 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 0f q(/0 undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this ap licadon is true and complete FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO.,..I 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: a REARDON CIRCLE SOUTH YARMOUTH,MA 02864 Alt.Tel.No.: y0 *Security System Contractor License required for this work;if applicable,enter the license number here: I.1 1 (t✓f/ OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability i urance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)fl owner ❑owner's agent. cl.. 15 s Owner/Agent PERMIT FEE: $ Signature Telephone No. .. The Commonwealth of Massachusetts .0,50=0111.111m,= Department of Industrial Accidents _ Sall l= Office of Investigations ..= 1 Lafayette City Center ` ="?'= � 2 Avenue de Lafayette, Boston,MA 02111-1750 -`" ` - www.ma,ss.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 aAre you an employer?Check the appropriate box: Business Type(required): 1. I am-a employer with e: ployeefi 11 and! S. 0 Retail ___ or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7 ❑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 area corporation and its officers have exercised 9. 0 Entertainment • •their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]** 4.❑ We are a non-profit organization,staffed by volunteers, 11.0 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 criminalpenalties of a fine up to$1,500.00 and/or one-year imprisonment, as well asci v it 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. Signature: r —• /..... 01/02/2020 Date: Phone#: 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): 10Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.DLicensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#• www.mass.gov/dia TOWN OF YARMOUTH o ' % BUILDING DEPARTMENT h++,` . y 1146 Route 28, South Yarmouth, MA 02664 MATTA 1 . 508-398-2231 ext. 1263 Fax 508-398-0836 K. Elliott,Inspector of Wires kelliotavarmouth.ma.us November 3,2020 Richard Melvin E. F. Winslow Plumbing & Heating 8 Reardon Circle South Yarmouth, MA 02664 Location: Elizabeth Myers, 15 Samoset Road, So. Yarmouth Permit Number: BLDE-21-000710 Dear Rich; The above noted location inspection failed to pass for the reason(s) listed. Article 210-8(A) GFCI Circuit breakers required. Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained,to the property, for the re-inspection. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth,Building Department K. Elliott, Inspector of Wires