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Home My WebLink AboutBLDE-21-003579 J►' : ,A� � ° Commonwealth of Official Use Only eso'rIZ��' ��. Massachusetts Permit No. BLDE-21-003579 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: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 perform the electrical work described below. Location(Street&Number) 46 SCHOLL AVE Owner or Tenant BISSETT JOANNE Telephone No. Owner's Address 46 SCHOLL AVE,WEST YARMOUTH, MA 02673 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: Replacement HVAC. 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 Above in- No.of Emergency Li tug �_ No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units y No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No of Zon No.of Switches No.of Gas Burners 1 No.of Detection n U/Cn Initiating Devi s `C. r ®:,P i. No.of Ranges No.of Air Cond. 1 Tons tal No.of Alertin ld�viiki s.d ,,_ No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contain /v6.".-. Totals: Detection/Alerting De 4 r j ` No.of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ s titer: 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: $50.00 \ IIA '3 f 3o (2-t t� y' /2( i i Official Use Only _ _ _ commonwealth of Massachusetts -�t Permit No. a2-1 --3579 Department of Fire Services IOccupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/O5 ] (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 z'YPE ALL INFORMATION) Date: 2_ I l ti 1 Z 0 City or Town of: rot 1'VIA( J 4 To the Inspector of Wires: By this application the undersigned gi es noti of is or her intention to perform the electrical work described below. Location (Street&Number) `l \1 ►y(ou I 02 6 Owner or Tenant G .e. C -- Telephone No.5g3 VZ z o( Owner's Address 5 O I/1/K.. Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building ' ,t J \`i4( Utility Authorization No. Existing Service Amps j / Volts Overhead n Undgrd n No.of Meters New Service Amps / Volts Overhead n Undgrd n No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: J f'/I r ctce i A,(� l6s4(llu1(61/1 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 hdIJ.of DCLCLGIU,I and 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 HeatingKW Municipal Local❑ Connection_ ❑ Other No.of Dryers Heating Appliances KW Security Systems No.of Water No.of Devices 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 desireg 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 b 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:) I certify,under thepains andpenalties o perjury,that the information on this application is true and complete. fP 1 Y, FIRM NAME: E.F. WINSLOW PLUMBING& HEATING CO., IN S Licensee: RICHARD MELVIN LIC.NO.: 3281C s--= enter "exempt" Signature LIC.NO.:21829A P Address b`8 REARDON CIRCLE S SOUTH YARMOUTH,MA 02664 the license nuinber line) Bus.Tel.No.: 508-394-7778 1 *Security System Contractor License required for this work;if applicable,enter the license number Alt here:No.: 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. I PERMIT FEE: $ I Department of Industrial Accidents �.i Office of.Investigations Lafayette City Center 2Avenue de Lafayette,Boston,.11dA 021111750 • ", V.' www.mass.gov/dia• • 'V olrltei ' Compensation Insurance Affidavit: General Businesses Applicant.Information • Please Print Legibly Business/Organization Name: E.1+. 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: Xiusiness Type(required): 1,Ei I am a employer with 90 employees (full and/ 5• ❑Retail or part-time)." 6, ❑Restaurant/Bar/Eating Establishment 2.II I am a sole proprietor or partnership and have no 7. o Office and/or Sales•(Intl,real estate,auto,etc.) employees working for me in any capacity. [No workers' comp, insurance required] - 8.C 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 no employees. [No workers' comp. insurance required]'* 11 Ifealtli Caro 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 infonnntiori, "If the corporate officers have exempted'themselvos,but.the corporation has other employees,a workers'compensation policy is required and such an organization should check box 1 am an employer that is providing workers'compensation insurance for my employees'. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Tnsurer'G Aridt'ess: .. City/State/Zip: Policy#or Self-ips.Lie.#1909A . Expiration Date;01/01/2021 Attach a copy of the workers' gompensatioan policy declaration page(showing the policy number and expiration date). Failure to secuk4 poveruge as'required under§25A.of MU,c. 152 can lead to the imposition of criminal penalties of a fine up to i 1,500.00 anclor one-year imprisonment, as well as civil penalties in the.form of a STOP WO=ORDER and a fine of up to S250.00 a day,against the violator. Bo advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage'verification. X do hereby Oergyrithilef the littIns and penalties ofperJury that the information provided above is true and correct. ignature; (/� Date: 01/02/2020 Phone#: 508.394-7778 Official use(Atty. .Do not write in this aren,,to be completed by city or tot4n official. City or Town:, Permit/License# Issuing Authority(check one); 10Board of health 2.0 Building Department 3.0 City/Town Clerk 4.D)Acensing Board 50 Selectmen's Office 6.❑Other Contact Person: . Phone th www.tnnss,gov/dia