The URL can be used to link to this page

Home My WebLink AboutBLDE-22-000814 ��\ Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-000814 e.e0 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 Codc (MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:8/12/2021 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) 8 DEVONSHIRE LN Owner or Tenant Elaine Frongillo Telephone No. Owner's Address 8 DEVONSHIRE LN,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 No.of Meters New Service Amps Volts Overhead 0 Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install air conditioning. 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 Above ❑ In- ❑ 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. 1 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 0 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 Ballasts Data Wiring: Heaters Signs 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 pennit 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:1 am aware that the License does not have the liability insurance coverage normally required by law.But my 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: $50.00 CX < < <31u - &t 6 14 Lt l Commonwealth of Massachusetts Official Use Only '' FF,, ►�o r Z2 — i`c *fAlll! Department of Fire Services Permit No. e?y=.°«_i Occupancy and Pee Checked <,,,t� BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/ova (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE.PRINTINMK OR TYPE ALL IN rORMATION) Date: '( /' aj City or Town of: Y/MOili ldf'f" To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to performthe eleotrioal work described below, Location(Street&Number) be%/0vtcWre "1ifT U1Odr OI( ), Owner or'Tenant Gi,ilk$ Fruit lid Telephone No,?$( S$y g qL,/ Owner's Address ~"v Is this permit in conjunction with a building permit? Yes I I No I-- -....--TCheck.Appropriate Box) Purpose of Building t oJt 41.01 Utility Authorization No. . "/Existing Service Amps : / Volts Overhead n 'Undgrd n No.of Meters New Service Amps / Volts Overhead n Ylndgrd I I No,of Meters Number of Feeders and Amps city Location and Nature of Proposed Electrical'Work: i,C ;n5417►((a h(c94 Completion of the followin•table may be waived by the Inspector of Wires, • No.of Recessed Luminaires No.of Ceil.-Susp,(Paddle)Pans No.of Total Transformers KVA No.of Luminaire Outlets No. of Hot Tubs Generators X VA No,of Luminaires Swimming Pool Above t- I In-. 1—j No.of Emergency Lighting grnd. I i grnd. I I Battery Units No.of Receptacle Outlets No.of Oil Burners (FIRE ALARMS No.of Zones y No.of Switches • No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges No.of AirCond. Tons No.of Alerting Devices No.of Waste Disposers LCeatPump Number Tons 7( 1 No.of Self-Contained Totals: ............... .....•.......,., ..,,,,....•.. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Loca1I I Municinecptialon I I Other • Coxa No.of Dryers ITeating.Applianees KW Security'systerns:* No,of:Devices o No,of Water No, of No, of Renters IOW Data Wiring: Signs Ballasts No.ofDevices or Equivalent • No.I yd>:ornassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E_guivalent OMER: Attach additional detail `'desired,,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy,) lf•N Work to Start; Inspections to be requested in accordance with iV1EC 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 �,/� ' � U OTIdBR ❑ (Specify:) �, I certify,under'the pains and penalties ofpeujury, that the infm'rnailon on this ap lication.is true and complete. ,....D EZA1V[NAME; >;,F, WINSI OW PLUMBING &HEATING CO„ I MC,NO.;328'iC Licensee; RICHARD MI i.VIN Signature -~ - LIC,NO,:2'13 829A (If applicable,enter"exempt"in the license number line)V Address; s REARDON CIRCLE SOUTH YARMOUTH,MA 02e84 Bus.Tel,No,:5os-394'7778 Alt.Tel. To,; (V *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. .am the(check one Downer owner's agent, Owner/Agent �►, 1 ❑ Signature Telephone No, JPEMJTF)l'E: $ I ' E.F. Winslow Inspection Department email: inspections@efwinslow.corn The Commonwealth of Massachusetts --_ Department of In clustrialAccidents °• "' Office of Investigations i<= y 1�I�IItl1� 1� ,. =A Lafayette City Center l'„VINE;K s 2 Avenue de Lafayette,Boston,MA 02111-1750 ''4 i �r" www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/OrgAnizationName: 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 aro a employer with 90 employees (full and/ 5. El Retail — or part-time).* _ 6. U Restaurant' r/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/ Sales(incl.real estate,auto,etc.) employees working for rre in any capacity. [No workers' comp. insurance required] 8. El None pro ut 3.❑ We are a corporation and its officers have exercised 9. n Entertainment their right of exemption per c. 152, §1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit oxgani7ation, staffed by volunteers, . with no employees. [No workers' comp.insurance req.] 12.0 Other . • *Any applicantthat 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. X 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 MGB G. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year ini isonu ieri as well as civlpezraities ittthe form of a STOP WORK ORDBR d-a fhm 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 car 'y,-ttnfie; the ins aa/nd penalties ofperjury that the information provided above is true and correct. Sinatux e. /1' -�-,. U. ,..ol, ..-- Date: 01/02/2021 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): 1.0Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.ElLicensing Board 5.0 Selectmen's Office 6.°Other . Contact Person: Phone#: www.tnass.gov/dia 1