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Home My WebLink AboutBLDE-22-001296 _ �• i 9 7.X Commonwealth of official Use Only € Massachusetts Permit No. BLDE-22-001296 _ 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:9/7/2021 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) 20 EIDER ST Owner or Tenant LEARY JOYCE H Telephone No. Owner's Address 2283 LAKEWOOD DR, NOKOMIS, FL 34275 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 ductless heat pump 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 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: 1 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 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:) 1 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 *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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 ❑ owner's agent. Owner/Agent Signature Telephone No. 'PERMIT FEE:$50.00 I i Cal lXXOX7fl cal o 114a5'5r7C CXSP S Official Only ��0f1_ ! _ Y t'Oa;0 Department of.fire Services Permit No. e? yrf BOARD OF FIRE PREVENTION Occupancy and>iao Checked °•�t� T( N REGULATIONS • [Rev.9/O�j (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL RK All work to be performed in a000rdance-with the Massachusetts Bleotricai Code(MBC),527 CMR 12,00 u 4 • (Pz l An I.c T.IN'/VC OR TYPE ALL JN. FORMATION) Date: I Z 1 K2 City or Town of: _ To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below, Loeatioxi(Street&Number)l� S Owner or Taint �tnrrn�y 1" 0f Q Z 05 C. Owner's Address Telephone No, izi Is this p exxnit in conjunction with a building pen-nit? Yes I I No Purpose o f adding ,A V` (Check Appropriate Box) Utility Authorization No. • BxistingSer-vice Amps . / Vol ts Overhead——---- v E '(Indgr•d No.of Meters New Service Amps / Volts Overhead I Undgrd Number of Feeders andAnxpaeity ❑ No,of Meters Lo cation and Nature of Proposed Electrical'Work: k e i/1S- i,lIn 4- co N o.o£>Re Corn letion o the o17owIn tgb/e inbe waived b the Ins Bator'o W I'es, cessed Luminaires No.of Ceil.-Sus addle)Bans No, of Total p Transformers KVA No,of Luminaire outlets No. of Hot Tubs Generator's XVA No,of Luminaires Swimming Pool Abe I In- .No.of.t Mer•gencyLig(xtug No.of Receptacle Outlets xud' ❑ Bette Units No.of Oil Burners SPIRE ALARMS No,of Zones No,of Switches No.o f Gas Buxxxexs on No.of Detection and ThOond, Tota Devices s No.of Alerting D evices No,of asteDisposexs Heat Pump Number ,'Sons 7f W No:of Self-Contained Totals: .............:............ No.of bishvvaslxexs Detection/Alartin Devices Space/area Heating KW Local E 1VSunieipa Connectioln Other No.of Dryers IleatingAppliances KW Seeur'ity'S steins: No,of Water No, of No,of leyices or uivalenf lleatexs Si VV Si rxsallasfs Data Wiring: No,X�(ydrorxrassage Bathtubs No.of Devices or g uivalent • CJ No. of iY(otars Total TSB Telecommunications Wiring: LJl OTHER: No,of Devices or i uivalent Attach additional detail fdesirecl,or as required by the Inspector of Wires, Estimated "Value of Electrical Work: Work to Start; (When required by municipal policy,) Inspections to he requested in accordance with lv1EC Rule 10,and upon completion. (.-el INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issueval •. '1a the license 0 provides proof ot'liability insurance including"completed operation"coverage or ifs substantial equivalent. unless undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office, enf. The �, CHECK DM: INSDRA.NCE 0 BOND ❑ OTHER I certify,trade the pains am mollies o ❑ (SpeC]fy I� f pey fzr�y, Thal the irifoxn7atton on this ap iication is triFe rcnci complete. (v L paplyt 1\aIV E; E P, VVINSLOW PLUMBING & HEATING CO„ I i Licensee; DIEHARD MEL.VIN LSE,NO,;328'IC (Iy'app1/cgble, enter "exempt"inthe license number I7ne.) Signature ..r--- • LIC.NO.:2'1829A Address; a RRAROON OIRcLR SOUTH YARMOUTH,MA ozss4 roe-3s4 777e*Security System Contractor License required for this work;if applicable, enter the license number here; No'r --------- OWNER'S INSURANCE Alt.Tel.No,: WAIVER: I am aware That the Licensee does not have the liability insurance coverage normally required bylaw. By my signature below,I hereby waive this requirement. I am the (check one) , r'/Agent (�(�� Signatureolynerr_1JuWnc a Sa�erlf, Telephone No, .PE.RIV T.P.81g' ' E.F. Winslow inspection Department email: inspections cr efiniinstow.com The Commonwealth of Massachusetts Pw. Department of In clustrialAccidents i=�� — Office of investigations M =a,��= Lafayette City Center _ r .- 2 Avenue de Lafayette, Boston,N14. 02111-1750 .,4.,ipws�r49 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): I.1Ui 1,am a employer with 90 employees(full and/ 5. U Retail or part-time).* 6. 1 1 Restaurant/Bar/Eating Establishment 2.1 1 I am a sole proprietor or partnership and have no 7. 1 ( Office and/or Sales (incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8 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.[Manufacturing no employees. [No workers' comp. insurance required] * 11.1 A Health Care 4.1 ( We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12.n Other . ' *.Any applicantthat 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. X 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 date). 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 foii.0 of a STOP WORD 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. X do hereby car yr-pm i•the ins and penalties of perjury that the information provided'above is true and correct. Signature: (_ /�� * �.of 0 I/02/2021 xgn 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): LLjBoard of Health 21:Building Department 30 City/Town Clerk 4.[Licensing Board 5[Selectmen's Office 6.[Oilier Contact Person: Phone#: www.mass.gov/dia