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Home My WebLink AboutBLDE-21-001472 ,, Commonwealth of Official Use Only filti- Massachusetts Permit No. BLDE-21-001472 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' JRev.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:9/22/2020 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) 73 CLEVELAND WAY SQs S ,.523 LiZ'74 Owner or Tenant SULLIVAN GERARD L Telephone No. Owner's Address SULLIVAN3357 VIRGINIA M, 16 TEAL CIR,WALPOLE,MA 02081 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: Washer/Dryer receptacle 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 1 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/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 Siens 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 9/- /soe-c9 `2//4(21 KiA i a ize(-20 Kg-- - q/,c(z -(9.sa" $) Commonwealth of Massachusetts Official Use Only in * —(t`-C7 2- 'n' N Permit No.Department of Fire Services 1 " 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 C),527 CMR 12.00 0 (PLEASE PRINT IN INK OR TRE ALL INF TION) Date: °I I i t a 0 City or Town of: 7 A Ai� `V, 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&Nufnber) —7 3 C ? &vl c Wei ` VCAY 6-1- lk Owner or Tenant .1 kkIL W\Lek- S,-Ali, t ‘/ctrl Telephone No. 50&5a34a:� Owner's Address .S P r E Is this permit in conjunction with a building permit? Yes 0 No Er (Check Appropriate Box) Purpose of Building X )Ridu,Ail Utility Authorization No. Existing Service Amps / olts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters U ` �Number of Feeders and Ampacity cv') Proposed (j( �,*p<Location and Nature of Electrical Work: t 1 1, "'-'��pA , V I 4y6 f/G�� ger Anln AE)'F'„-, 'Ti9AL rr _ /.v1 .711r GtLaS ,_ r c„ - .H . . ...• i - A _ Com.letion o the ollowin: table m' be waived b the Ins sector o Wires. (7) No.of Recessed Luminaires No.of Ceil:Susp. adFans o•o ota 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. 0 Battery Units 0/1 No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and TotaInitiating Devices No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices 0 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices 1 No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑ m CI Connection No.of Dryers Heating Appliances KWSecurity S stems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Iiydrornassage 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. 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 0 OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information ois true and complete FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO> !/h1catb0n , ILIC.NO. 3281C Licensee: RICHARD MELVIN SignaturLIC. 2 NO.: 1829A (lfapplicable,enter "exempt"in the license number line.) 21 508.3944 778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02884Alt.Tel.Bus.Tel.No.; *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 in rance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) owner D owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ I ,65,eet hon se ecl ..,,t -v car^ • The Commonwealth of Massachusetts -'^r �!1 Department of Industrial Accidents ra Office of Investigations Lafayette City Center ��II V 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 I Are you an employer?Cheek The appropriate box: Business Type(required): 1.0 I am a employer with 90 employees (full and/ 5• 0 Retail or part-time).* 6. 0 Restaurant/Bar/Eating 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. 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]** 4.0 We are a non-profit organization, staffed by volunteers, 11.0 Health Care 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#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 Insurer's Address: City/State/Zip: Policy#or Self-ins. 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 secure-e ..,.ab a ,e under§25A-of MOL 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 ce /"` el the ins and penalties of perjury that the information provided above is true and correct. Signature: Y Gf/ I 01/02/2020 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 3.0 City/Town Clerk 4.0 Licensing Board 5.0 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia