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Home My WebLink AboutBLDE-21-002598 Commonwealth of Official Use Only ' Massachusetts Permit No. BLDE-21-002598 I 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:11/9/2020 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 work described below. / Location(Street&Number) 26 HOLLY LN 7 3— r�3(4' ✓�/ t, Owner or Tenant ODONNELL WILLIAM J Telep one No. Owner's Address ODONNELL CATHERINE A, 17 KENSINGTON DR, BILLERICA, MA 01821-3057 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 receptacle for dryer. 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. 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 1 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:) L 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 Commonwealth of Massachusetts Official Use Only *-_°= /, Permit No. (=ZI — Z"�ci f3 Department of Fire Services Occupancy and Fee Checked =Vim= BOARD OF FIRE PREVENTION REGULATIONS [Rev. MI5] (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 INFORMATION) Date: Ilk / KO City or Town of: Ye,irYtoUi-I - To the Inspector of Wires: By this applic ition the undersigned gives notice of his or her intention Ito perform the'electrical work described below. Location (Street&Number) �,� I\o\I.) L yi �)(-)i A, /0,,1%✓I ai-1 4 V Z b G 7 Owner or Tenant 'kortn Odom`"L +- Telephone No.5U� 5 V?/e g Owner's Address ILI Mo�Grl Wu vi TO it>h i/ M A 0 ) -2 Is this permit in conjunction with a building permit? Yes ri NoChec Ap : i!r«te "o 'j Purpose of Building ,1UJt%A Utility Authorization N . Existing Service Amps `� / Volts Overhead Undgrd n ''o.0 feter9 297� New Service Amps / Volts Overhead 1-1 Undgrd1-1oj,Nii:, ZlT_. Number of Feeders and Ampacity � Location and Nature of Proposed Electrical Work: Oil e,i ke ctP i-ett te. (IS Al /4" t zj7" Completion of the ollowin: table ma be waived by the Inspector o Wires. Total No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.roof KVA Transformers _ KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ 0.o Unitsmerg rg mg rnd. l rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones I. • No.of Switches No. of Gas Burners • t • Initiatin� Devices No.of Ranges No.of Air Cond. Tons ' ' ` ' -■ No.of Waste Disposers Heat Pump Number Tons KW o.of Self-Contained Totals: 1 • • •I I/4 • •I • Devices No.of Dishwashers Space/Area HeatingKW ocal❑ Municipal ❑ Other P Connecfton No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or E s uivalent No.of Water KW No.of No.of Data Wiring: Heaters Si:ns Ballasts No.of Devices or E s uivalent dromassa a bathtubs No.of Motors Total HP Telecommunications Wiring: No. H Y g No.of Devices or E•uivalent 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 V� the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The 4\ 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:) 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., IN LIC.NO.: 3281C V` Licensee: RICHARD MELVIN Signature LIC.NO.:21829A ,rt` N (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 5°8-394-7778 r 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: 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. PERMIT FEE: $ .:\ <ra4r c.ommonweattn of Massachusetts • ,„ Department of XnclustrialAccidents R " .Office ofInvestigations 6. Lafayette City Center •k, i 2 Avenue de Lafayette,Boston,MA 02111-1750 ' `,. www..mass.gov/din. • Workers' Compensation Insurance Affidavit! General Businesses Applicant'Information Please Print Legibly _ r Business/Organization Name: E,F. WINSLOW PLUMBING& HEATING CO, INC, • Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH, MA 02664 Phone 41:508-39477778 • Are you an employer?Check the appropriate box: Business Type(required): 1.El I am a employer with 90 employees (full and/ 5. 0 Retail 2.❑ or part-time).* 6, ❑Restaurant/Bar/Eating Establishment I am a sole proprietor or partnership and have no ?. 0 Office and/or Sales,(iilcl,real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. 0 Non-profit 3.❑ We are a corporation and its officers have exercised 9. El Entertainment their right of exemption per c, 152,§1.(4),and we have no employees. [No workers' comp.insurance required]** 10'Q Manufacturing 4.❑ We are a non-profit organization, staffed by volunteers, 11 ❑I Xealtli Care with no employees. [No workers' comp.insurance req.] 12.0 Other *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. *'*If the corporate officers have exempted'themseives,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 ingnrar's Addr,,,: City/State/Zip: Policy#or Self-ins,Lie.#1909A Expiration Date;01/01/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), • Failure to seour4 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 '" ' the ,.ins and penalties of penury that the information provided above is true and correct. lgnature:�.� ~� tom- 1---•^ 01/02/202 Date: 0 Phone#: 508-394-7778 Official use cAdy. Do not write in this area,to be completed by city or tot-n official. City or Town: Permit/License# issuing Authority(check yne): 1.EBoard of 1l(ealth 2.0 Building Department 3.0 City/Town Clerk 4.D ,icensing Board 50 Selectmen's Office 6.[Other Contact Pers?n: . Phone#: • www,mass,gov/dia