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Home My WebLink AboutBLDE-21-001872 � Commonwealth of Official Use Only .iNg Massachusetts Permit No. BLDE-21-001872 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:10/9/2020 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 w k described below. Location(Street&Number) 162 RUN POND RD e - S 32- *7 7 2 2 Owner or Tenant OTERI BARBARA C Telephone No. Owner's Address 289 WILDROSE COMMON UNIT 1, LIVERMORE,CA 94551 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check A i 'r. . :/ ,„,Purpose of Building Utility Authorization No. �, �' ExistingService 100 Amps Volts Overhead 0 Undgrd 0 41114°-`c.. ! • ems► g New Service 100 Amps Volts Overhead 0 Undgrd 0 :New Number of Feeders and Ampacity �'+ 4,t,,' Location and Nature of Proposed Electrical Work: Replacement of service. # , ,s Completion of the following table may be waived by e' • ,f Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of 'i Transformers • No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting krnd. 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 ❑ 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:) 1 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 $/4 Telephone No. PERMIT FEE:$50.00 36( `u , 5/z1/24 Jetr ,Lc 'T pvb,c) lig 2 Nt 06/N l • • Commonwealth of Massachusetts Official Use Oily Permit No. •- t 6 .,�_ Department of.Fire Services -I 4 Occupancy and Pee Checked . - 0 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 Eldotrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK ORTYP ALL INFORMATION) Date: y/�Q f 20 City or Town of: NialM O i/ 1 To the Inspector of Wires: By this application the undersigned gives notice of his pr h r i tention to perform the jjel��ectrical work described/ below. Location(Street&N ber) -I 6 a R VA PM 0 /IQ/ 50441 Y41n 1 at/7�1 DZ('7 Owner or Tenant , Jim 6--1-11;;i Telephone No, (/Q 5 a 77 a,2 Owner's Address '1‘561- I 4reSe_ Comrno' 1-;vet'n?Oct CA 4YSS1 Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building .UIQ\\`A.U. Utility Authorization No. • Existing Service /OD Amps ..//t/Zcc/ Volts Overhead lal Undgrd 0 No.of Me• ters / New Service /oD Amps /2d/ZVs Volts Overhead Undgrd / g D No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrkal Work: /0 d MP 0 ieike aid Sect/,'ce• • completionsofthe•fpllowingtable may be waived byllie inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.Middle)Fanshs •• No.Of ' Total Middle) Transformers , , KVA _ No.of Luminaire Outlets No.of Hot Tubs Generators ' . KVA No.of Luminaires Swimming Pool.Above In- No.of Emergency Lighting Hr nd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo,of Zones No.of Switches No.of Gas Burners No.of Detection and I Initiating Devices ToNo.of Ranges M.of Air Cond. • of sl No.of Alerting Devices No.of Waste Disposers Heat Pump I Number 'Tons 1KW No.of Self-Contained Totals: I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal 1-1 Connection. 0 Other No.of Dryers Heating Appliances KW Security•Syystems:* ; No.of Water No.of Devices or E9uivalent TCW No.of- No.-of TreatersSigns Ballasts Dataring: No.of Devices or 1A}rty»lent No.Hydromassage Bathtubs No.of Motors Total HP , Telecommunications Wring: OTHER: No.of Devices or Equivalent Attadh additional detail t/desired,or as required by the Inspector of Wires. c Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested.iit accordance with MEC Rule 10,and upon completion, s INSURANCE COVERAGE; Unless waived by the owner,no pertnit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial•eiluivalent. The undersigned certifies that such coverage is In force,and has exhibited proof of same to the permit issuing office, (--- 1\ CHECK ONE: INSURANCE 0 BOND 0 OTHER D (Specify:) I certify,under the pains and penalties ofpe,/ury,•that the information on this ap Iication is true and complete. FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO,, I LTC.NO.:3281 C Licensee: RICHARD MELVIN LIC.NO.:21829A � nSignature ( 'applicable,enter "exempt"in the license number•lirie) .808.354.7778 CD fkiN Address: a REARDON CIRCLE SOUTH YARMOUTH,MA 028e4Alt.Tel.Bus.Tel.No.: 11[�', Vl *Security System Contractor License required for this work;if applicable,enter the license number here:No.., �-l.l 4 . OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability nsurance coverage normally ' required by law. By my signature below,I hereby waive this requirement. I am the(check orie)i❑owner JJ owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE:$ • • • I 5 The Commonwealth of Massachusetts • :� Department oflndustrialAccidents ; •Office ofInvestigations ie tl LafayetteCity Center 2 Avenue de Lafayette,Boston,MA 02111-1750 "� •• www..mass.gov/dia Workers' Compensation Insurance Affidavits General Businesses A &ant.Information • Business/Organization Name: E.F. WINSLOW PLUMBING & HEATING C Please Print Le .131O, INC. Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH, MA 02664 Phone#:508-394-7778 Are you an employer?Check the appropriate box: l.El I am a employer with 90 Business Type(required): employees (full and/ 5. 0 Retail or part-time).* asole proprietor or partnership and have no 6. restaurant/Bar/Ear,,,Q Rs{a •bitc- . employees working for me in any capacity. h' crt 2.Q ram 7. ❑Office and/or Sales,(incl,real estate,auto,etc.) 3.❑ [No workers' comp. insurance required] 8. ❑Non-profit We are a corporation and its officers have exercised their right of exemption per c. 152, 1 9. ❑Entertainment no employees. p.§ (4),and we have 10[�Manufacturing [No workers' comp. required]** 4.❑ We are a non-profit organization, staffed by volunteers, 1 I Ilealtli 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. **lf 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: • • Policy#or Self-ins.Lic.#1909A Attach a copy of the workers' policy Expiration Date:01/01/2021 Compensation olic 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 to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the.form of a STOP WORK $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations fine up the DIA for insurance coverage Verification. ORDER and a fine of up to __ gations of I do hereby cer ', • •7 the .ins andpenalties operjurythat the information provided above is true and correct • f i.nature. , •Y —• �....,�1...... Phone#: 508-394-7778 Date: 01/02/2020 Official use only. Do not write in this area,to be completed by city or town official City or Towm• . permit/License# Issuing Authority(check one); 1.0Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.[]Licensing Board • 5.[]Selectmen's Office 6.DOther Contact Person: . Phone#: www.mass.gov/dia • . I I