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Home My WebLink AboutBLDE-21-003557 Commonwealth of Official Use Only kt • Massachusetts Permit No. BLDE-21-003557 • 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:12/26/2020 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) 3 LEXINGTON LN Owner or Tenant HARWICK JEAN TR Telephone No. Owner's Address 3 LEXINGTON LN,YARMOUTH PORT,MA 02675 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 boiler. 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 1 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 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: 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 24 let. r2V,4 Official Use only "_. commonwealth of Massachusetts (___=�,1_ Department of Fire Services Permit No. -�f �- -7 TCV 5 Occupancy BOARD OF FIRE PREVENTION REGULATIONS ] and Fee Checked �''..•0' [Rev.9/05] (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 TY E ALL INFORM4TIOIV) Date: 11 /1//Zt City or Town of: }o ri7/01/I-h 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)-2) /-4()((t/1(„�o 7 1---41---4y��dJHie'C1/7L026-? 5 / Owner or Tenant 3eitvt ktviki1C(( J Telephone No. S /6 ag 5G 2 2* Owner's Address 501 wie Is this permit in conju ction with a building permit? Yes ❑ No Er (Check Appropriate Box) Purpose of Building cit Ak � YU/ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ 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: 36; e,i l frisa tiati-e0,-/ • Completion of the,(ollowing 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- ❑ o.of Emergen *l�ighting grnd. grnd. Batter Units ; '�'a. No.of Receptacle Outlets No.of Oil Burners I FIRE ALARMS } � � , No.rof toiks� No.of Switches No.of Gas Burners '• ' "• � ` Initia ' g '+ev'S+ � , No.of Ranges No.of Air Cond. Total t*' Tons No.of Alerting-Devices c-8 No. No.of Waste Disposers Heat Pump Number Tons KW No.of Se ntalued �� Totals: Detection/Ale • Det�,ic No.of Dishwashers Space/Area Heating KW Local 0 Muniicipction ', i' 'e Conne No.of Dryers Heating Appliances KW Security stems: =� / 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 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. c. 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 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 thepains and penalties operjury,that the information on this application is true and complete. p f FIRM NAME: E.F. WINSLOW PLUMBING& HEATING CO., IN �' Licensee: RICHARD MELVIN / LIC.NO.: 3281C c`A (` Signature LIC.NO.:21829A • d V� (If applicable, enter "exempt"in the license number line.) Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.:508-384-7778 o *Security System Contractor License required for this work;if applicable,enter the license number Althere:No.: cJ . OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally 2 required by law. By my signature below,I hereby waive this requirement. I am the(check one Owner/Agent )0owner 0 owner's a ent. Signature Telephone No. p PERMIT FEE: $ Department ofIn(1ustrialAccidents ms,µ i'= . ice of Iiavest>'gatlons `�1'"'= Wipe City Center u'1i 2 Avenue de Wayettea Boston,Mel 02111-1750 • 444,1-o6 wwwmass.govldia. • Workers'Compensation Insurance Affidavit: General Businesses Annlicant<iinformation Please Print Legibly . Business/Organization Name: E.F.WINSLOW PL:UMSING&HEATING CO, INC. • Address:8 REARDON CIRCLE • City/State/Lip:SOUTH YARMOUTH, MA 02664 Phone !:508-3°4;7778 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 80 employees(full and/ 5. '0 Retail or part-time).* 6, ❑Restaurant/Bor/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl,real estate,auto,eta.) employees working for me in any capacity. , [No-workers'comp.insurance requiredi 8. 0 Non-profit 3.0 We are a corporation and its officers have exercised 9. 0 Entertainment • their right of exemption per c, 152,§1(4),and we have 10,0 Manufacturing no employees.[No workers' comp.Insurance required]"* MO ealtli Care 4.0 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 pheck bqx#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 Tnsnrer'a AAtd+•et City/State/Zip: • Policy#or SfA s,Lie.#1909A Expiration Date;01/0112021 Attach a copy of the workers' ooinpensatlon policy declaration page(showing the policy number and expiration date), • Failure to seourft coverage as required under§25A of Ma,a.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anti/or one-year Imprisonment, as well as civil penalties in the.form of a STOP WO=ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for insttrhnce coverage Verification. .1 do hereby der '. e the Ins and penalties ofperJury that the information provided above is true and correct, t 1�. ` ' , 01/02/2020 �ianature. k", ! Date, Phone#: 508-3847778 Official use oily. Do not write In this area,to be completed by city or ton)n official • City or Town:' • Permit/License# Issuing Authority(check one); • IClBoard of lilealth 2.0 Building Department 3.0 City/Town Clerk 4.1:1A,icensing Board ' 5.[]Seleetmdn's Office 6.[(Other Contact Person: . Phone#; • www.mass,gov/dia . 1 i