The URL can be used to link to this page

Home My WebLink AboutBLDE-21-003381 Official Use Only �.�. Commonwealth of Permit No. BLDE-21-003381 ; � Massachusetts 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:12/15/2020 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) 97 ELDRIDGE RD Owner or Tenant MADDEN ROBERT B Telephone No. Owner's Address MADDEN MARION P,97 ELDRIDGE RD,SOUTH YARMOUTH, MA 02664-5746 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: Receptacle for dryer. 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: Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal 0 Other: Connection No.of Dryers 1 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 ❑ (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 ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $50.00 06S- 24V — -\= commonwealth of Massachusetts � =**_V- t Official Use Only 1 f= I- Department of Fire Services Permit No. r �— = BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [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 T PE ALL INFORNATIO City or Town of: �� ll ) Date: J 2 /1 / () a/n(ll� To the Inspector of Wires: By this application the undersigned gives notic of hi or her intention to perform the electrical work described below. Owner Location o (T Street&Number t( 'Q d 50U ' a eu* ().-Ka. . q Tenant �(� � 21 �0.��S CL Telephone No. 50$3 p1 I/6 a 7 g Owner's Address M C �Pr--Pe,\6 , t- AOO' cj\ I O Q� Is this permit in conjunction with a building permit? Yes n No v Purpose of Building p inJ ; �, �f (Check Appropriate Box) P \1 11 Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters New Service Amps / Volts Overhead Undgrd n No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: OA 1-e {- -r e /lecf � C Qrt er. 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. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners I FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners % Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: i Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection Di Other No.of Dryers Heating Appliances Kam, Security Systems: No.of Water KW Heaters Signs Ballasts No.of No.of Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Devices or Equivalent g No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent 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 ❑ OTHER ❑ (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., IN Licensee: RICHARD MELVIN LIC.NO.:3281C Signature LIC.NO.:21829A • LP (If applicable, enter "exempt"in the license number line.) f� Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.:508-394-7778 *Security System Contractor License required for this work;if applicable,enter the license num elr ere: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/Agent )❑owner 0 owner's a ent, Signature Telephone No. PERMIT FEE: $ Department oflnctustrialAecitients • 'aE Office oflnvestigations ' —/ ._.:,g Lafayette City Center " 24venue de Lafayette,..Boston,21d.4 0.2271 x750 'Nizi' . wwH.massgov/dta. • Workers' Compensation ZnsuranceA#'#idavit: General Businesses Annlicani Informtatlon Please Print Legibly I Business/Organization Natne: E.P.WINSLOW PCUMBINO&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): 1,0 I am a employer.with 00 employees(niland/ 5. ❑Retail • or part-time).* 6' estauxant/Bar/Eating Establimeht 2,CITama sole proprietor or partnership and have no employees working for me in any capacity, 7' 0 Office and/or Sales(9ncl,real estate,auto,eta.) [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 • no em to ees, �* 11 Manufacturing p, y (,No workers comp,insurance reguiredT 4.0 We are a non-profit organization, staffed by volunteers, l 1.Qeaitli Care with no employees.[No workers' comp.Insurance req.] 12.0 Other *Any applicant that checks box ill mast also fill out the section below showing their workers'compensation policy Information, **lithe corporate officers hags exempted'themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check 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 111CItrp,'e Addnedr: City/State/Zip: • Policy#or Self-ins,Lie.#1909A Expiration pate;01/01/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expjration date). Failure to secur&ooverage as•required under§25A of MGX,o. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 anclTr 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 of this statement may be forwarded to the Office of investigations of the DIA for insultmce coverage Verification, -- • 1 do hereby der ' e the Ins and penalties ofperjury Mat the t ormatlon provided above is trace and correct, ,Signature: , '(1, a... .1...,.•. )Date: 01/02/2020 • Phone#: 508.3944.7778 Official use oily. Do not write in this areas to be completed by city or town official. flcial. City or Town:, Permit/License# issuing Authority(check one); t.DBoard of lilealth 2.0 Building Department 3,(]City/Town Cleat 4.DX,icensing)3oard 5o Selectmen's Office d.❑Oilier Contact Person: Phone#: www,tnass,gov/dla ' 1 . i