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Home My WebLink AboutBLDE-21-003584 Commonwealth of Official Use Only l' Massachusetts Permit No. BLDE-21-003584 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:12/28/2020 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 22 MUSKET LN Owner or Tenant Gary Babineau Telephone No. Owner's Address 22 MUSKET LN,YARMOUTH PORT, MA 02675-2127 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: Instal generator Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddlej Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting grnd. grad. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo f Zones 414,, No.of Switches No.of Gas Burners No.of Detection and 9.j._ 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:) 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:$75.00 C:b`f-I *24 (2( W...-. '-\___ commonwealth of Massachusetts Official Use Only 1-2 'iii Permit No. �Z4 `" '3c6/-4 :,41,-_-----3-_ � Department of Fire Services ,. 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 Code NEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1 Z/ Z l / (. 0 City or Town of: `joii jnO JF Ik 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) Z', Mdskt r y ctivir.f l port 0 7 6 ? 5 Owner or Tenant 61/(1 6r6,ne U Telephone No.7 7 9 50 Z 9 C/S Owner's Address 9git • Is this permit in conju ction with a building permit? Yes n No F--(Check Appropriate Box) Purpose of Building \1,1 `\1 Vl' �` Utility Authorization No. Existing Service Amps / Volts Overhead n Undgrd g I-1 No. of Meters New Service Amps / Volts Overhead ( I Undgrd n No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Cervqtvi (t/l j1a 1IK 1-10r1 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 '• ' ' " " Initiating Devices 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 _ 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 I 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. J 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:) N I certify,under the pains and penalties of p Gerjury,that the information on this application is true and complete. N FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., IN 9� LIC.NO.:3281C o Licensee: RICHARD MELVIN Signature -, : ---_____ LIC.NO.:21829A • 1 fr* (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.: 508-394-7778 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: 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. I am the(check one) ❑ owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ Department of IngustrialAecidents N Office of:Investigations ,;:, Lafayette City Center ='��" .Boston,MA 02222-1750 v:�1-.:.� 2.�lvenue tle.,t;afayette, • wwrv..>wncrssgov/dta. • Workers' Compensation Insurance Affidavit: General Businesses Applicant.'Information Please Print Legibly . Business/Organization Name: s.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: ;3ttsiness Type(required): Es employer 1, I am a with 00 employees(full and/ 5. �El Retail or part-time) 6, ❑Restaurant/Bhr/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, g, El Non-profit [No workers' comp.insurance required] 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 no employees. [No workers' comp.insurance required]'' 11 0'Sealtli Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees, [No workers' comp.insurance req.l 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informatlori. q'*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 41, I am an employer that Is providing!porkers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY TnetNar'a Add" City/State/Zip: Policy i#or Selfns,Lic.#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 secur4,coverage as'required under§25A of MGL 0. 152 can load to the imposition of criminal penalties of a fine up to$1,500.00 anc/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 advisedl that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage Verification, GGU/,Grit' ao 'ir• ''c"the .t'rinn and penalties X ' '" y .�. w .....,, .. 1 p ..tes cfper�ttry that the Information above is true and correct, lanature: � �'* «�� Date: 01/02/2020 Phone#: 608.394.7778 Official use oily. Do not write in this area,to be conwleted by city or toOn official. City or Town:', • ,Permit/License it issuing Authority(check one); 1.DBoard of Aealth 2,0 Building Department 3.0 City/Town Milt 4.D),icensing Board 5[j Seleetme'n's Office 6,DDOthiei- Contact Pgrs9n: . Phone#; www.mass,gov/dia