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Home My WebLink AboutBLDE-21-003795 0 A . Commonwealth of Official Use Only II. j Massachusetts Permit No. BLDE-21-003795 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:1/8/2021 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) 7 WEBFOOT WAY Owner or Tenant SPOHN ROBERT F Telephone No. Owner's Address 7 WEBFOOT WAY,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No ❑ (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 ❑ Undgrd ❑ 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 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 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 Number Tons KW No.of Self-Contained Totals: Detection/Alerting 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 Heaters KW No.of No.of Data Wiring: 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 (Jl,4 31 474 Lin) _- -�= commonwealth of Massachusetts Official Use Only __ _-__ ( - `�� ' —` i_ Permit No. 8-2 - , --,�— Department of Fire Services 1 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 TYPE ALL INFORMATION) Date: (Z /Z Li/20 City or Town of: ;otoriN t-L 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& umber) IN {(j(�" k ik 016 7 S Owner or Tenant Kobel ' / 1" h Telephone No. 5 05'562 9v 7' Owner's Address Sa Is this permit in conju ction with a building permit? Yes I I No f.�(Check Appropriate Box) Purpose of Building I--1 w.Q ,' Utility Authorization No. Existing Service Amps J / Volts Ov erhead ❑ Undgrd n No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 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 ALARMSNo.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 Number Tons IKW No.of Self-Contained Totals: I { 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal Connection 11.Other No.of Dryers Heating Appliances KW Security Systems -- — " -" No.of Water No.of No.of No.of Devices or Equivalent Heaters KWData Wiring: Signs Ballasts No.of Devices 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: (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.07 i (If applicable, enter "exempt"in the license number line) Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.: 508-394-7778 Alt.Tel.*Security System Contractor License required for this work;if applicable,enter the license number here:No.: k. f OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally �.S required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner = Owner/Agent ❑owner's agent. Signature Telephone No. I PERMIT FEE: $ I t Department ofIntlustrialAecidents -. ' .Office of Investigations . Lafayette City Center "'°`"" 2Avenue de Lpfayettea Boston,MA 02212 2750 r'i_ . • w WWW.J°72[aS,S.g'OV�[lia Workers'Compensation InsttranceAff davit: General Businesses .Apolicaniinformation • 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 I Are you an employer?Check the appropriate box: Business Type(required): , ,� 1. I am a omployer with 80 employees(Hall and/ 5. 0 Retail or part-time).* 6, 0 Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7, 0 Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. No:.-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,E]Manufacturing no employees.[No workere' comp.insurance required]s'* 11,[]1ealtlt Care 4,❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] t2,D Other *Any applicant that cheeks 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 pluck 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 Tnanrer'e Arldresr: City/State/Zip: • • „ Policy#or Self us,Lie.#1909A Expiration Date:01/01/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), . Failure to seour4 coverage as requked under§25A:of MGL c.152 can load to the imposition of criminal penalties of a fine up to$1,500.00 ancllor one-year imprisonment,as well as civil penalties in the.forxn of a STOP WO=ORDER and a fine of up to $250.00 a day,against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of Investigations of the DIA for Instfrhnce coverage'verification. - I do hereby tier e the ins and penalties of perjury that the ttiferrruatlon provided above is trite and correct. i nature: l"`"� l�. � Date: 01/02/2020 . g Phone#: 608.394.7778 Official use only. Do not write in this area,to be completed by city or torpn official . City or Town:, Permit/License# Issuing Authority(check yne); . 1.DBcard of ifealth 2.D Building Department 3,D City/Town Clerk 4.D),icensing Board • 50Seleetmtn's Office 6.0OWer Contact Pirs?n: . • Phone#; • www,mass,gov/dia , ,