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Home My WebLink AboutBLDE-21-007416 Massachusetts 0Commonwealth of Official Use Only .�, Permit No. BLDE-21-007416 ' E.� ,�� 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:6/21/2021 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) 237 NORTH MAIN ST Owner or Tenant DAVENPORT DEWITT TR Telephone No. Owner's Address DAVENPORT REALTY TRUST,20 NORTH MAIN ST,SOUTH YARMOUTH, MA 02664-3150 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: Air handler&condense , ` {'- Completion of the following table may be waived by the Inspector of Wires. No.of Total No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. 1 Total No.of Alerting Devices No.of Ranges Tons Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine Devices Municipal 0 Other: No.of Dishwashers Space/Area Heating KW Local 0 Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens Ballasts No.of Devices or Equivalent Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. required Value of Electrical Work: (When q uired by municipal policy.) y' 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 LIC.NO.: 21829 Licensee: RICH M MELVIN Signature (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. I PERMIT FEE: $80.00 Commonwealth of Massachusetts Official Use Only i (c, Permit No. -74( _;=o__= Department of Fire Services `T�`(- Occupancy and Pee Checked a BOARD OF FIRE PREVENTION REGULATIONS ?v.,;„�, [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.zN.INK OR TYPE ALLINFORMATIO.N) Date: 6 /7 0/ City or Town of: Vj ult/►otJM, 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) r 3.i (Ylc,, v► S'tl''-e.P'+ / S . '(Ctr(V1 c.`v�� Owner or Tenantry,r„r,008 �tciCd l)6 ., -1 Q Telephone No. 6'06-39P Z2 to, Owner's Address S4 iiC Is this permit in conjunction with a building permit? Yes No I (Check Appropriate Box) Purpose of Building Utility Authorization No. (lo Existing Service Amps • / Volts Overhead I I Undgrd I I No.of Meters New Service Amps / Volts Overhead I I Undgrd I I No.of Meters Number of Feeders and Ampa city 1 Location and Nature of Proposed Electrical Work: Pi ✓ •�vi d- -f dorr;C i (un t-F .3CS ) ( completion of the following may be waived by the Inspector of Wires. / l (Y) No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans T of T Transformers JKVAVA No,of Luminaire Outlets No.of Hot Tubs • Generators X VA Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grad. I I grad. I ( Battery Units No.of Receptacle Outlets No.of Oil Burners TIRE ALARMS No.of Zones No.of Switches • No.of Gas Burners No.of Detection and Initiating Devices . N. No.of Ranges No.of Air Cond. Total No.of AlertingDevices Tons Heat Pump Number Tons KW No.of Self Contained No.of Waste Disposers Totals: Detection/Alerting Devices " No.of Dishwashers Space/Area Heating I VtI Locall I Municipal I I Other Connection No.of Dryers Heating Appliances IOW Security'Systeins:* No.of Devices or Equivalent No.of Water I NoW ,of No, of Data Wiring: Heaters Signs Ballasts No.of Devices or Eglxivalent 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; 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 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 ❑ OTHER ❑ (Specify:) , I certify,under the pains and penalties ofperju y, that the information on this ap lteation is true and complete. FIRM NAME; E.F. WINSLOW PLUMBING&HEATING CO., I�1 .LIC,NO.:328'IC Licensee: RICHARD MELVIN Signature LIC.NO,:21829A (If applicable, enter "exempt"in the license number line.) l Bps.Tel.No..508-394-'7778 Address; 8 REARDDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.No,; *Security System Contractor License required for this work; if applicable,enter the license number here: 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's agent, Owner/Agent .. _ ., Signature Telephone No, .PE.IdliT FEE: $ ' E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts • Department of IndustrialAccidents _v Office of Investigations 10-1 Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02111-1750 IMOwww 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.n I am a employer with 90 employees (full and/ 5. n Retail or par I. ne).* 6. ji Restaurant/Bar/Eating Establishment 2.I 1 I am a sole proprietor or partnership and have no 7. 1111 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.I I 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.[]Health Care 4.1 I We are a non-profit organization,staffed by volunteers, 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. Lie.#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 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 ' e.the and penalties ofpeijury that the information provided above is true and correct. ,f/ 01/02/2021 Signature: ?' "" -�^° 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 2.111 Building Department 3.0 City/Town Clerk 4.[Licensing Board 5.1 I Selectmen's Office 6.[Other Contact Person: Phone#: • www.inass.gov/dia