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Home My WebLink AboutBLDE-21-003827 Commonwealth of Official Use Only Massachusetts 'Ai Permit No. BLDE-21-003827 tel 0BOARD 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:1/11/2021 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) 16 BENJAMIN WAY Owner or Tenant HIGH ALTA M Telephone No. Owner's Address 16 BENJAMIN WAY,WEST YARMOUTH, MA 02673b• i -4ap Is this permit in conjunction with a building permit? Yes 0 No 0 (Check pro'Qom' Purpose of Building Utility Authorization No. Existing Service 200 Amps Volts Overhead 0 Undgrd 0 o I f r 41' 1., New Service 200 Amps Volts Overhead 0 Undgrd 0 c 1 o ,.o. a♦\ a Number of Feeders and Ampacityaiiirt lr III Location and Nature of Proposed Electrical Work: 200 amp meter&service conductors. 0 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 No.of Luminaire Outlets No.of Hot Tubs Generators ,) KVA No.of Luminaires Swimming Pool Abo ❑ In- ❑ No.of Emergency _ tin grndve. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALAR ,•N r of 2 "'Y '$ No.of Switches No.of Gas Burners No.of Detection a , C . Initiating Devices c ` 40 7 No.of Ranges No.of Air Cond. TonsTotal No.of Alerting Device "PC 'ft, \ 7 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained \cam Totals: Detection/Alerting Devices ,. (, No.of Dishwashers Space/Area Heating KW Local ❑ Municipal is Connection0 \ O er. 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 perjuiy,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: $50.00 _— \ commonwealth of Massachusetts Official/��Use Only *lit" tPermit No. l��t -3g 2_ Department of Fire Services 7 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 CMP C),527 CMR 12.00 (PLEASE PRINT IN INK OR Y/E ALL INFORMATION) Date: //(//Z 0 City or Town of: i eltwoii I-14 To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perfonn� the electrical CUwrk described below. Location(Street&Number) 1 6 d t von n W UUf 5 F l cv Cid-42 )3 Owner or Tenant t\ 1 �'i J ,vl Telephone No. 50��6 a& 3 7 Owner's Address `2 GI,VIne, • Is this permit in conjunction'\with a building permit? Yes 111 No 1- ----------(—Check Appropriate Box) Purpose of Building ,J�t\,\q ✓Lid/ Utility Authorization No. Existing Service ZD3 Amps 120 / ?lib Volts Overhead n Undgrd V No.of Meters / New Service 7A5O Amps / ZO/ Z(ld Volts Overhead n Undgrd w No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 20o Vitr Vo i d0�Ad alcSK1r-iiicLr �1 C ;t d ucti-ost.s Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.of Emergency Lighting grnd. grnd. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Damtion mid Initiating Devices Tot 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❑ Municipal ❑,Other Connection i No.of Dryers Heating Appliances KW Security Systems:/'- No.of Water No.of Devices or Equivalent No.of No.of Data Wiring: Heaters KW 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 ifdesired 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 0 (Specify:) - I cert,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., IN LIC.NO.:3281C r,) col 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 Tel.No.: *Security System Contractor License required for this work;if applicable,enter the license number here: ‘...1. -,..nOWNER'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: $ I Department oflnclustrlalAcctdents .Office of Xnvestigatlons • Milli= Lafayette City Center 2 Avenue de Lafayette,.8os1on,MA 02.122-2750 ov/dta. • www.mass.gov/dia. Compensation Insurance Affidavit: General Businesses Anplicant,Xnformation 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#:608-304,7778 Are you an employer?Check the appropriate box: Business Type(required): 1.EI I am a employer with 90 employees(fltll and/ 5. 0 Retail or part-time).* 6, 0 Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7, 0 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. 0 Entertainment • their right of exemption per c, 152,§1(4),and we have 10.0 Manufacturing no employees. [No workers' comp.insurance required]'"* 11.0'Sealtli Care 4.0 We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.Insurance req.] 12.0 Other *Ally applicant that checks box#I must also fill out the section below showing their workers'compensation policy information, •*If the corporate officers have exempted'themsalves,but the corporation has other employees,a workers'compensation policy Is required and such an organization should check bqx#1, I ant an employer that is providing workers'compensation Insurance for my employees. Below is the policy information. Insurance Company Nara:ARROW MUTUAL INSURANCE COMPANY Tnanrer'a Arbiresa: City/State/Zip: Policy#or Soluos,X,ic.#1909A Expiration Date;01/01/2021 Attach a copy of the workers' eoznpensatioin policy declaration page(showing the policy number and expiration date), Failure to se0ur4 coverage as required under§25A of MGL 0.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anti/or one-year itnprisorunent, as well as civil penalties in the.forrn of a STOP WORX,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 instirknee coverage Verification, 1 do hereby tier ' el the lns and penalties of perjury that the in ormatlonprovided above is true and correct, signature: °� rG�• ,� _- Data, 01/02/2020 Phone#; 608-3947778 Official use o)`tly. Do not write in this area,to ha ooiapleteel by city or town affteial. City or Town: Permit/License# issuing Authority(check one); l.DBoard of ealth 2.0 Building Department 3,0 City/Town Cleirk d.DAAcensing Board 5[(Selectnu n's Office 6.0Otliei- Contact Person: . • Phone 0: www,mass,gov/dia