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Home My WebLink AboutBLDE-20-005801 g Commonwealth of Official Use Only Massachusetts Permit No. BLDE-20-005801 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:5/13/2020 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 descri d below. Location(Street&Number) 52 GOLFERS CIR 77f5 - 1,199 '774-53s" 149. i Owner or Tenant CLARK WILLIAM E TRS Telephone No. Owner's Address CLARK MARJORIE I TRS,67 MALDEN ST,WEST BOYLSTON, MA 01583 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Approp Oft ) Purpose of Building Utility Authorization No. / Existing Service Amps Volts Overhead 0 Undgrd ❑ e O New Service Amps Volts Overhead 0 Undgrd 0 kjii o l t''• RA Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement boiler. 0 :gip, Completion of the,following table may be waived by th v o , ires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of T` ' Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o 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 1 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 ❑ 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 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: 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 N `T( zo a "'l4- '4/(51'21v - NA_ -) 2,vw ( ._._ A Commonwealth of Massachusetts f,O�ffi7ciaal Use Only...) i =* t Permit No.. 2-6 Sol 0 t-'sit Department of Fire Services Occupancy and Fee Checked 1-111-",''''',...7,.,.. BOARD OF FIRE PREVENTION REGULATIONS [R.ev.9/OS] (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 TYPE ALL INL'ORMATION Date: 5/6/2-0 City or Town of: Yirir u fil 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) �).,, • ir,-. 4.► 01,- ` Owner or Tenant il'Q'1\ 014A I A,Ik Telephone No. Owner's Address .1 19 C r 'f ip A I, C r/1 ' 6 1 • Is this permit in conjuncl tion with a building permit? es ❑ No j- (Check Appropriate Box) Purpose of Building wC\\c vim Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters ------____--__.._New-Service- - Amps--- ---/ - Volts —Overhead-0 Undgrd❑ -Nov-of-Meters- Number No of-Meters Number of Feeders and Ampacity . Location and Nature of Proposed Electrical Work: t e i 0 5 f y( a - d yl Completion of the following fable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of.Ceil:Susp.(Paddle)Fans Tof T Transformers KVAVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- No.of Ener` gLighting No.of Luminaires Swimming Pool 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 Detectionand 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❑Municipal ❑Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of No.of Devices or Equivalent KWData 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: Inspections 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. -- t`r. CHECK ONE: INSURANCE ® BOND 0 OTHER 0 (Specify:) . S I certify,under the pains and penalties of pedury,that the information on this ap lication is true and complete. r FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO., III .LIC.NO.:3281C lam' S' S Licensee: RICHARD MELVIN Signature LIC.NO.:21829A l (If applicable,enter-'exempt"in the license number line.) Bus.Tel.No.;5084944778 r-J Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02864 Alt.Tel.No.: f'-J ^5 *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)Downer ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ • The Commonwealth of Massachusetts Department of IndustrialAccidents iv-=' jt Office of Investigations ,, i . Lafayette City Center ‘41.0) 2Avenue de Lafayette,Boston,MA 02111-1750 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): 1.0 I am a employer with 90 employees (full and/ 5. 0 Retail -----__-_ _.__-or parGtirrte)4 —_ -__--- --- _�---- ------ 2.0 I am a sole proprietor or partnership and-have no 6. ❑Restaurant/Bar/Eating Establishment 7. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 8. 0 Non-profit [No workers' comp. insurance required] 3.0 We area corporation and its officers have exercised_ - ._9.. ❑.Entertainment__. _. ___ _ . _ _ _ _ _ _ - - their right of exemption per c. 152, §1(4),and we have no employees. [No workers' comp.insurance required]** 10 Manufacturing 4.0 We are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp.insurance req.] 12.0 Other *My 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. I 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: i Policy#or Self-ins.Lic.#1909A 21 Attach a copy of the workers' compensation policy declaration page(showing the policy number0and0expiration 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 and/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 ' e the 'ins and penalties of perjury that the information provided above is true and correct. Signature-. /-- - G ,..-1 Date: 01/0212020 .. . 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): 1.DBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.[]Licensing Board 5.[]Selectmen's Office 6.[]Other f Contact Person: Phone#: I www.mass.gov/dia i