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Home My WebLink AboutBLDE-21-007192 0 Commonwealth of Official Use Only '1 Massachusettsii Permit No. BLDE-21-007192 ii- 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:6/10/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perto the electrical work described below. \ Location(Street&Number) 4 FOREWIND RD (-nn1 q 12 -1 fVD.,. 61 /4 ) Owner or Tenant NOYES ROBERT F Telephone No. Owner's Address NOYES SHIRLEY M,4 FOREWIND RD, YARMOUTH PORT, MA 02675-1322 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 furnace. 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 , No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting rid. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners 1 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 I Number I Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local 0 Municipal Connection ❑ Other: No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of evices or Equivalent Heaters KW No.of No.of Data Wiring: Signs Ballasts No.of Devics or Equivalent No.Hydromassage Bathtubs 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: Work to start: (When required by municipal policy.) 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 operjury,that the information on this applications 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.) Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Bus.Tel.No.: 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 Commonwealth of Massachusetts Official Use Only ► - '— t, � �l1 '7( 7jz. =�_��,-= M Permit No. � (, —,;,��= Department of Fire Services ).,=1_� Occupancy and pee Checked % = BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05j (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 FRINT.INMK OR TYPE ALL INFORMATION) Date: 6/3/ Z I City or Town of: Vamp,' P071 To the Inspector of Wires: By this application the undersigned gives notice of hisnor her intention to perform the electrical work described below, wind K.J 16,40nJ ric/40/t Vocation(Street&Number) � 1'd(� l Owner or Tenant f,eifL d g C c L Telephone No.�(Z 60 6 I Owner's Address (, j U `01C 5 I--, Loi t��Io , 1 lit E'j., e,q 7,Z Is this permit in conjunction with a building permit? Ws No 1-4-"'"--(Check Appropriate Box) Purpose of Building Qw{,\\t 1A, Utility Authorization No. Existing Service Amps . / Volts Overhead I I Undgrd I 1 No.of Meters New Service Amps / Volts Overhead I I Undgrd I I No,of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical'Work: Kuhl U,C2 t yil S,L.1 6;fi l4 Completion of the followin•table may be waived by the Inspector of Wires, raVA No.of Recessed Luminaires No.of Ceil.•-Susp.(Paddle)Fans T of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs • Generators KVA No.of Luminaires Swimming Pool grnd e grad. I ( Battery Units No. rgeacy Lighting 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 g No.of Waste Disposers Heat Pump Number Tons IOW No.of Self Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local1 I Monnectiounicipaln I I Other C No.of Dryers Heating Appliances KW Security'systems:* No.of Devices or Equivalent No.of Water No.of No, of IOW Data Wiring: Heaters • Signs Ballasts No.of Devices or Equivalent • No.Hydrornassage 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. Zj 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 ifs 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 FA BOND El OTHER 0 (Specify:) I cent fy,under the pains and.penalties ofperjury, that the information on this ap licatiorr is true and complete. FIRM NAME; E,F, WINSLOW PLUMBING & HEATING CO, I .LIC,NO.:3281 C 4.....D .1a Licensee; RICHARD MELVIN Signature • LIC.NO.:21829A r 5" (If applicable, sate' "exempt"in the license number line) Bps,Tel.No,:5oe-394'777s L✓ Address; 8 REARDON CIRCLE SOUTH YARMOUTH,MA o2e64 Alt.Tel.No,; t 'r *Security System Contractor License required for this work; if applicable,enter the license number here: N 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)I, owner owner's agent, Owner/Agent . - Signature Telephone No, PEWIT FEE: $ ' E.F. Winslow inspection Department email: inspections@efwinslow.com The Commonwealth of Massachusetts Department of IndustrialAccidents • Office of Investigations f�l17 i A ;= I Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 Nei" 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): 1.11 I am a employer with 90 employees (full and/ 5. ❑Retail or part-time).* 6. Li Restaurant/Dar/Eating Establishment - 2.1 ( 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•U Manufacturing no employees. [No workers' comp. insurance required]** 4.1 I We are a non-profit organization,staffed by volunteers, 11.❑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.#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 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 cer ' el•the ins and penalties of perjury that the information provided above is true and correct. Signature: 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): 1. (Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.[Licensing Board 5.1 Selectmen's Office 6.[(Other Contact Person: Phone#: • www.lnass.gov/dia