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Home My WebLink AboutBLDE-21-003807 or1 ^' Commonwealth of Official Use Only / Massachusetts Permit No. BLDE-21-003807 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked IRev.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:1/11/2021 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) 16 EAGLE LOOP Owner or Tenant BUTLER THOMAS F JR Telephone No. Owner's Address 16 EAGLE LOOP,YARMOUTH PORT, MA 02675-1106 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 generator. 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 1 KVA No.of Luminaires Swimming Pool Above 0 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 Initiatine 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/Alertine 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 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 e ort-- 1(242-4 LKo eatecc c/1/ k `-N= commonwealth of Massachusetts Official Use Only►-gr= Department of Fire Services Permit No. - BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked�� [Rev.9/051 (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 IIVINK OR TYPE ALL INFORMATION) Date: 4 ) /_J MO City or Town of: 'arvf00.-4 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) 16 Eokr,1`e L GO!_ Y414110I/ f h110/J- DZ 6 7 5 Owner or Tenant I ho i 5,)4-(pTelephone No. 50WZC-K0 Owner's Address %/71 e Is this permit in conjunction wih a building permit? Yes n No f (Check Appropriate Box) Purpose of Building 1)10 ,Vt Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd g ❑ No.of Meters New Service Amps / Volts Overhead n Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ►?e�qb✓ i 5i 'lr td t7N 7ZCm_, tf /w0-t 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 grad. grnd. Batte Units — No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 'No.of Gas Burners '• ' Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No. ofSelf-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Mipal ❑, Coanectunicion Other No.of Dryers Heating Appliances KW Security Systems No. of Water No.of Devices or Equivalent No.of No.of KW Heaters 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 l ',,,, the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The t : undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ® BOND 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. l� FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., IN LTC.NO.:3281C � a Licensee: RICHARD MELVIN Signature LIC.NO.:21829A • (If applicable, enter "exempt"in the license number line.) 506-394-7778 N a Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664Alt.Bus.Tel.No.: V *Security System Contractor License required for this work;if applicable,enter the license number 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 Jv i. . �_... Department of%nt'ustrialAeeidents .Office oflnvesttigations Lafayette City Center �iY I RL>•1 .... 2Avenue de Lafapettaa Boston,MA 02.111-.1750 'ter: .' www..mcrss.gov/dta• • Workers'Compensation Insurance Affidavit! General Businesses Annlicant:xnformation Please Print Legibly . Business/Organization Name: 1;,P, WINSLOW PLUMBING&HEATING CO, INC. Address:8 REARDON CIRCLE City/State/Zip:,SOUTH YARMOUTH, MA 02664 Phone 608494;7778 Are you an employer?Check the appropriate box: Business Type(required): 1.El I am a employer with 90 employees(fhll and/ 5. 0 Retail or part tima).* - 6. QRe5taurant/Rvr/Bating Establishment 2,0 I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl,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. 0 Entertainment their right of exemption per e. 152,§1(4),and we have 10,0 Manufacturing no employees.[No workers' comp.insurance required]'" i 1 ealtl�i Care 4,0 We aro a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.0 Other *Any applicant tint cheeks box#1 must also fill out the section below showing their workers'compensation policy informatiori, *If the corporate officers have exempted'themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should piteek box I am an employer that lar providing workers'compensation insurance for my employees. Below is Me policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY suraea Adrir'esr: City/State/Zip: • . Policy#or Self ins,Lie,#1909A Expiration Date;01/01/2021 • Attach a copy of the workers' coinpensatiotx policy declaration page(showing the policy number and expjration date). Failure to seourcl,00verage as xaquired under§25.A:of MGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anc/or onelear irxrprisomnent, as well as civil penalties in the.foxm 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 instirlince coverage'verification, 1 do hereby t'er ' e Mei Ins and penalties of perjury that the Wormatlonprovided above is true and correct, lanature: 7 ' ' /,�L'«�W,(. �.^ Date,, 01/02/2020 • Phone#: 608.394.7776 Official use oky. Do not write in this area.,to be aonwleted by city or totnn offtclrtl, City or Town: •Permit/License# Issuing Authority(check one); 1.QBcard of ttealth 2.D Building Department 3.0 City/Town Cleirk 4.C] ,icensing Board 5(�Seleotmfln's Office 6, • [(Otlieir Contact Pgrs4n: . • Phone#; www,mass,gov/dia