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Home My WebLink AboutBLDE-22-001285 o'00413 Commonwealth of Official Use Only E' Massachusetts Permit No. BLDE-22-001285 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:9/6/2021 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) 106 PINE ST Owner or Tenant DEE RICHARD 0 Telephone No. Owner's Address DEE MARY H, 106 PINE ST, YARMOUTH PORT, MA 02675-1839 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 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,to of Zop // No.: : : s No.oasurnerso. No.of Air Cond. 1 Ton Total No.of A • No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Con ' t O Totals: Detection/Alerting : •v No.of Dishwashers Space/Area Heating KW Local 0 M n ici lion • O 1 .e .C No.of Dryers Heating Appliances KW Security Systems:* O 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 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 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 Ce9icr 61,0, LOgl2P77( e6 Commonwealth of Massachusetts Official Use Only I=_*= — / Permit No. e Z2' �g v1= Department of Fire Services „ Occu anc and Fee Checked �",.-(yi BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/ 5]y .. (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code( A C),527 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFO TION) Date: �J' .� 2/ City or Town of: A- DGLj t P& To the Inspector o Wires: By this application the undersigned gives //,c)e 'ce of his or her inte ion to perform the electrical work described be ow. Location(Street&Nu er)g /o 5rc .j 5 ' Owner or Tenant X jG.ff~ t` Telephone No. . 23� Owner's Address .5/7/14 Is this permit in conjunction with a building permit? Yes n No n (Check Appropriate Box) LC/ Purpose of Building //ii&) Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd❑ 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: 1LA–Z�Zde...)r c 7// x/,l/Tiv/e- -4, CCS' A./L',� 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 AboveIn- No.of Emergency Lighting grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones Norof.Detecti�o o.o wic es Mi.of Gas Burners _ — — — 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 El Other No.of DryersHeating AppliancesKW m Connection 'SecurityS stes:* No.of Devices or Equivalent No.of Water 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: ;\ Estimated additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Worlc: (When required by municipal policy.) v l 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 ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this ap lication is true and complete. • c3N FIRM NAME: E.F.WINSLOW PLUMBING &HEATING CO., IV LIC.NO.:3281C Licensee: RICHARD MELVIN Signature - LIC.NO.:21829A i (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 n owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. • E.F.Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents V __ Office of Investigations ' -"�l Lafayette City Center TA_ 2 Avenue de Lafayette,Boston,MA 02111-1750 •••,-' WWW.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information 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#:508-394-7778 Are you an employer? Check the appropriate box: Business Type(required): 1. I am a employer with 90 employees (full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 111 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Nor-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]** 11.0 Health Care 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 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#I. 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 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 dater Failure to secure 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 cern�e the 'its and penalties of perjury that the information provided above is true and correct. .f j�f j 01/02/2021 Signature: �' Date: 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): 1fBoard of Health 2.0 Building Department 31:1City/Town Clerk 4.LI Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia 9i:71;`1-4'\\,t_ TOWN OF YARMOUTH ' o BUILDING DEPARTMENT o 1146 Route 28, South Yarmouth, MA 02664 $ 508-398-2231 ext. 1263 Fax 508-398-0836 K. Elliott, Inspector of Wires kelliott(ayarmouth.ma.us September 21, 2021 Richard Melvin E. F. Winslow Plumbing & Heating 8 Reardon Circle South Yarmouth, MA 02664 Location: 106 Pine Street, Yarmouth Port Permit Number: BLDE-22-001285 Dear Rich, The above noted location inspection failed to pass for the reason(s) listed. Article 210-63 Receptacle required within 25' Please forward the required re-inspection fee of eighty dollars ($80.00) to this office and advise when the corrections have been made and when access may be gained, to the property, for the re-inspection. If you have any questions please do not hesitate to contact me. Sincerely, Town of Yarmouth, Building Department K. Elliott, Inspector of Wires