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Home My WebLink AboutBLDE-21-004132 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-21-004132 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.l/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:1/26/2021 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) 277 SOUTH SHORE DR Owner or Tenant THE 277 SOUTH SHORE DR LLC Telephone No. Owner's Address PO BOX 370, SOUTH YARMOUTH, MA 02664 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check A,pLtp, Box Purpose of Building Utility Authorization No. iiii;w Aft. Existing Service Amps Volts Overhead 0 Undgrd 0 s. Il'',y1. Iv, Aim Arr, New Service Amps Volts Overhead 0 Undgrd 0 1 1 .. te-111 Zell` Number of Feeders and Ampacity ' . . r Location and Nature of Proposed Electrical Work: Replacement water heater. °0 4 Completion of the following table may be waived by of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of To Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ElNo,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 Initiatine 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/Alertine 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 1 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: 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 0 owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $80.00 A- 7/c/ u (leeAY2-6/z-/) L execto 7 O' o' cA.A itis i/moi � „ > Commonwealth of Massachusetts /Offficial Use Only t -**-911?= / Permit No. (.iZ` — �1 � „__ vl Department of Fire Services • Occupancy and Fee Checked e, -'�,� BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] »''`If�7. (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 TYJE ALL INFORMATION) Date: I // /2 City or Town of: /AMC/(AL h 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)7 7 S 0, L4 Sl- ie b c. 500-k 0,,r#0SA O 2 C V Owner or Tenant ScIF 5tin d PI0 4-e I Telephone No. SOS 3e g 3706 Owner's Address /u Is this permit in conjunction with a building,permit? Yes El No R"------(Check Appropriate Box) Purpose of Building Co✓meet(q I Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd El No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity / / r / Location and Nature of Proposed Electrical Work: [,vtt.1-e r /164,t-,ev /2.54/41/oH Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Traa onTof Tsformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool AboveIn- 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 AlertingDevices 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 SecurityS stems:* No.of Water No.of Dwices or Equivalent _ __ No.of __No.of Heaters KW — 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 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. CHECK ONE: INSURANCE ® BOND ❑ OTHER ❑ (Specify:) • �- (�C I certify,under the pains and penalties of pedury,that the information on this ap Citation is true and complete. Uc FIRM NAME: E.F.WINSLOW PLUMBING & HEATING CO., Ifs LIC.NO.:3281C Z -.0 Licensee: RICHARD MELVIN Signature LIC.NO.:21829A t M (If applicable,enter "exempt"in the license number line) Bus.Tel.No.:508-394-7778 O .-_ Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: Q 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. 1 am the(check one)Downer ❑owner's agent. Owner/Agent I Signature Telephone No. PERMIT FEE: $ 1 u to. Le The Commonwealth of Massachusetts Department of Industrial Accidents A. Office of Investigations e �� Lafayette City Center 2 Avenue 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 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. ❑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 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 b no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, 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. 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.#1964A Expiration Date:01/01/2022 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-penaltiesof-a-fine-up to$1,500.00 and/or on -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 certify, un he i7§and p naoties o perjury that the information provided above is true and correct. Signature: �'' "' •02.6o9 dtaa-s5= 01/02/2021 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): l f Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia o1''Y:4TOWN OF YARMOUTH -A O BUILDING DEPARTMENT 0i 1'' . y 1146 Route 28, South Yarmouth, MA 02664 T' ESE'� K508-398-2231 ext. 1263 Fax 508-398-0836 K. Elliott, Inspector of Wires kelliott(a,varmouth.ma.us May 19,2021 Richard Melvin E. F. Winslow Plumbing & Heating 8 Reardon Circle South Yarmouth, MA 02664 Location: 277 South Shore Drive, South Yarmouth Permit Number: BLDE-21-004132 Dear Rich; The above noted location inspection failed to pass for the reason(s) listed. Article 110-12 Mechanical execution of work. 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