The URL can be used to link to this page

Home My WebLink AboutBLDE-22-001282 of.. Tt A Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-001282 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•9/6/2021 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) 44 KATHARYN MICHAEL RD U Owner or Tenant CRAY WILLIAM Telephone No. Owner's Address CRAY DONNA, 18860 MISTY LAKE DR,JUPITER, FL 33458 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 of 100 amp panel. 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. girnd. 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 Initiative Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton 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 Water No.of Devices or Equivalent KW No.of No.of Ballasts Data Wiring: Heaters Siens 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 I certify,under the pains and penalties ofperjury, that the information on this applications true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 21829 Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Bus.Tel.No.: *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 S' 41(V(24 ke Commonwealth ��o <' a h usetts Official Use Only (_;'ati= Department of Fire Services X'ermitS�To. ( Z-2_ — l Z'�Z- BOARD OF FIRE PREVENTION REGULATIONS Ocoupeney and Pee Checked ...�� [R ev.9/o5 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORKAll work to be performed in accordance with the Massachusetts Electrical Code (PLEASE..2).RI+1T.1N'.17�XC OR TYPE ALLIN.�'ORMITION) (MCI 5 z7 cMR 12.00 City or Town of: Date: ��t!� Y/ 0 Pi To the Inspector of Wires': By this application the undersigned gives notice of his or her i tention to per orm t e leotrical work described below, Location(Street&Nuraer) 4 1-14 `CN rr Owner or'Tenant k Ot � �e Telephone No, l Li 7 5 Owner's Address vyl Is this p erxnit in conjunction with a;building permit? Yes r No Purpose ofBnilding W� i/l (Check Appropriate Box) Utility Authorization No. Existing Service Amps J Volts Overhead Now Service C �rzdgrd No,of Meters Amps / Volts Overhead 'Urxdgrd Number of Feeders aud Amps city E No,of Meters Location and Nature of Proposed Electrical'4 o.k. Com.letiori o the ollowin:fable rns be waived b the.Ins sector o Wipes, No.of Recessed Luminaires No.of Ceil.-Susp.(paddle)pans No. of Total No, of JLuminaire Outlets Transformers No. of Hot Tubs • Generator's KVA. No.of Luminaires Swimming Pool : nd"e :r `o.o +zrrergency xg x'xng No,of teceptacle Outlets :rnd. ❑ Batte Mots No,of OiI Burners FIRE ALARMS No.of Zones No,of Switches • No. of Gas burners No.of Detection and No.of'Ranges xnitiatin• Devices No, o f r�ix Cond, ofa - Tons No. of Alerting Devices Heatd'uxn No,of Waste Disp osers p Number Tons x Totals: No.of Self-Contained No.of DishwashersDetectxon/A,lertin:Devices Space/Area Heating KW Local 0 1Vonueipal No, of Dryers Caxxrxeetxon ❑ Other rY Beating Appliances KW Seen rity'systens:* , No,of Water No of No,of Ikevices or C+ uivalent Heaters I'�V No, of Data miring;Si ns Ballasts No,Zlydx orxrassage Bathtubs No.of b evices or B -trivalent No. of Motors Total IJ[P Telecornm e ietions 1�1'7xang: ® OTHER: No,ofDorces oa'B uivalent _ Estimated Value of Electrical Work: (When additional detail if ed,or as required by the Inspector of Wires, Work to Start; (When required by municipal policy) Inspections to be requested in accordance with MEC Rule XD,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 o 'liability insurance including"completed operation"coverage or ifs substantial equivalent, alent undersigned certifies that such coverage is hr force, and has exhibited proof of same to the permit issuing office, The 'b CIGCI(ONE: INSURANCE Fij FOND ❑ OTHBI2 ❑ (Specify:) p %evilly,under the pains and penalties of pe)yzrty, Thai the inform[aeon on this ay' 1icrttion is Otte and complete. ~ OFIRM N E; E•F, WINSLOW PLUMBING &HEATING CO„ I Licensee; RICHARD MELVIN LIE,NO<.328'IC (llapplicable, enter"exempt"in the license number line.) Signature •Address; s REARnON cJRcLE SOUTH YARMOU X IC.N0. 21829A TFI,�/1A ola6¢ B:ua.Tel.No,:5oe'3s4 777a *Security System Contractor.License required for this work;if applicable, enter the license number here: ---------- OWNER'S INSURANCE Alt.Tel.No,:Z am aware that the Licensee daes not have the liability insurance coverage normally required bylaw, By my signature below,I hereby waive this requirement. I am the check one ne ie'/Agent r Signature ( o R ovner's��enl, Telephone)No, ..FERMI `RAW; 53' E,F, Winslow Inspection Department email: inspections a efwinsiow.com . The Commonwealth of Massachusetts • ` Department ofInclustrial.Acciclents 1`' Office of Investigations ig El _- �' Lafayette City Center '112I — 2.Avenue de Lafayette,Boston,ll 02XZL-1750 'a, s,�"� www.mass,gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Buz mess/OxganizationName: 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): 1.Wi I am a employer with 90 employee's (full and/ 5.-[1 etail or part-time).* 6. I I Restaurant/Bar/Eating Establishment . 2.1 I I am a sole proprietor or paa lrtership and have no 7. 111 Office and/or Sales (incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.1 I We are a corporation and its officers have exercised 9. 1 I Entertainment their right of exemption per c. 152, §1(4), and we have 10.n Manufacturing no employees. [No workers' comp. insurance requiredr* 11 n Health Care 4. We are a non-profit organization, staffed by volunteers, - with no employees. [No workers' comp.insurance req.] 12.0 Other . ' *Any applicantthat checks box#1 must also till out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,aworkers'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 MU c. 152 can lead to the impositionof criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the foaru 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 cer -y,-nn i'the ins and penalties ofperjuxy that the information provided above is true and correct.01/02/2021 g Si nature: /-° ,. /6/,„,�.,," 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): 1. Board of Health 2.[]BuildingDepartment 3.11City/Town Clerk 4.L Licensing Board 5.[(Selectmen's Office 6.['Other Contact Person: Phone#: • www.inass.gov/dia