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Home My WebLink AboutBLDE-21-003991 Commonwealth of I Official Use Only ` ` Massachusetts Permit No. BLDE-21-003991 ' 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:1/20/2021 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) 121 CAMP stwi Owner or Tenant Cheryl Scarangella Telephone No. Owner's Address 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: Second floor renovations, add sub panel, &add basement circuits. (BUILDING #88) Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans 1 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 Light' grnd. grnd. Battery Units a) No.of Receptacle Outlets 12 No.of Oil Burners FIRE ALARMS o.ofo, s\ �"t No.of Detectio nd - ,,.-- , No.of Switches 5 No.of Gas Burners a Initiative Dev es ��• No.of Ranges No.of Air Cond. Total No.of Alerting Dei'tces • y L'f 'w Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Conitained , '*„, Totals: Detection/Alerting Devices ' / M No.of Dishwashers Space/Area Heating KW Local 0 unicipal 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: 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 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 p_sweett 1/ a (_No -oc- pitr ep u f oc- zeirr) G 6077-17 le6 ',W." Commonwealth of Massachusetts Official Use Only • fl-will-71-iji = Department of Fire Services Permit No. t✓�I, �� c +-`- 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 INFORMATION Date: I�09 /2 1 City or Town of: ar ji4I-) To the Inspector of Wires: By this application the undersigns gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /Z / (a m,O S� //�l•._ . ,(S 1 � dv// 026 - 3 Owner or Tenant (ti(rl 1501Iail f7e//l a T ( 7 �I Telephone No./J Owner's Address yy 5 S 63 9 Sot vVj-e Is this permit in conjunction with a building permit? Yes �- Purpose of Building O�,,,�(lI`yl ❑ No L.` " (Check Appropriate Box) y Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd® No.of Meters New Service Amps _ / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Znn N 0 l'"loo it R40o u w fi o n ag o PA�+bt, Iq�(r yy epstsftc,u. �txe,vih- CompletioMof the followinpztable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus . No.of Total p (Paddle)Fans / Transformers KVA No.of Luminaire Outlets y 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 h- No.of Oil Burners "- FIRE ALARMS INo.of Zones No.of Switchess--- No.of Gas Burners No,of Detection and No.of Ranges Initiating Devices 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: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal No.of Dryers ❑Connection El Other t Y Heating Appliances Kam, Security Systems:* No.of Water No.of Dwices or E uivalent Heaters KW No.of Ko.of —— Data Wirin T — — Si ns Ballasts g�No.Hydromassage Bathtubs No.of Devices or E uivalent No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Estimated Value of Electrical Work: Attach additional detail if desired,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 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 ❑ OTHER ❑ (Specify:) (/ I certify,under the pains and penalties ofpei jury,that the information on this ap licatioh is true and complete. FIRM NAME: E.F. WINSLOW PLUMBING& HEATING CO., IV Licensee; RICHARD MELVIN LIC.NO.:3281C Signature icen((cable,enter "exemt"(n the license number line.) LIC.NO.:21829A Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.:508-394-7778 J *Security System Contractor License required for this work;if applicable,enter the license number here: Alt.Tel.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 Owner/Agent Signature �owner's a:ent. Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts t • Department of Industrial Accidents ZINZIrIZI ;� Office of Investigations _,, il, Lafayette City Center 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 Phone#:508-394-7778 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 90 employees (full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7 ❑ 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 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 4.ElWe are a non-profit organization,staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp.insurance req.] 12.111 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.#1964A Expiration Date;01/01/2022 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure_ta secure_coverage_as_required_under_§_25-A 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 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 certify, un he i and p, naoties o perjury that the information provided above is true and correct. Signature: s Date:01/02/2021 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): laBoard of Health 2.0 Building Department 3.D City/Town Clerk 4.[licensing Board 5.0 Selectmen's Office 6.1:Other Contact Person: Phone#: www.mass.gov/dia