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Home My WebLink AboutBLDE-22-005905 4/0 Commonwealth of Official Use Only t Massachusetts Permit No. BLDE-22-005905 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Y 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) 4/2022 City or Town of: YARMOUTH DTo the Inspector1 By this application the undersigned gives notice of his or her intention to perform the electrical work d scribed below. of Wires: Location(Street&Number) 71 ACRES AVE Owner or Tenant JANICE°REILLY Owner's Address Telephone No. 6175996714 Is this permit in conjunction with a building permit? Purpose of Building Yes CINo CI (Check Appropriate Box) Existing Service Utility Authorization No. Amps Volts Overhead ❑ 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: INSTALLATION OF 12 KW WHOLE HOUSE GENERATOR 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 Trans o r Total KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 12 No.of Luminaires SwimmingPool Above In- rnd. ❑ �rnd. ❑ No.of Emergency Lighting No.of Receptacle Outlets Batt•r Unit No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and No.of Ranges I itiatin' D•vice No.of Air Cond. Total No.of Waste DisposersNumber TonsNo.of Alerting Devices Heat Pump T i tals: KW No.of Self-Contained No.of Dishwashers D•t•0'e •1•rti,. D•vic• Space/Area Heating KW Local ❑ Municipal No.of Dryers o ea' n ❑ Other: Heating Appliances KW Security Systems:* No.of Water KW No.of •.of 1 •vi • or E I ival•nt at••r ins No.of Ballasts Data Wiring: •No.Hydromassage Bathtubs '. i f Devi •s or i u' a ent No.of Motors Total HP Telecommunications Wiring: OTHER: Ni. 'fD•v'c• or El ival•nt 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.) 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 I certify,under the pains and penalties o OTHER 0 (Specify:) (perjury,that the information on this application is true and complete. FIRM NAME: Rich M Melvin Licensee: Rich M Melvin Signature (If applicable,enter"exempt"in the license number dine.) LIC.NO.: 21829 Address:8 REARDON CIR, S YARMOUTH MA 026641207 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 my signature below,I hereby waive this requirement.I am the(check one ) 0 owner 0 owner's agent. Signature Telephone No. CIN PERMIT FEE:$50.00 Commonwealth of Massachusetts Official Use Only Permit No. — Uo? -j Cjp rat Department of Fire Services I=I Occupancy and Fee Checked -..0,n BOARD OF FIRE PREVENTION REGULATIONS [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:04/09/2022 City or Town of: YARMOUTH(WEST) 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)71 ACRES AVE,W.YARMOUTH, MA 02673 Owner or Tenant JANICE OREILLY Telephone No. (617)599-6714 Owner's Address SAME Is this permit in conjunction with a building permit? Yes ❑ No ❑✓ (Check Appropriate Box) Purpose of Building DWELLING Utility Authorization No. Existing Servic+" Amps / Volts Overhead❑_ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd 0 No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: INSTALL 12KW WHOLE HOUSE GENERATOR 2'OFF THE BACK LEFT SIDE OF THE HOME 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 1 KVA 12 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No.ofSelf-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Co Municnnectipional ❑Other No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water No.of No.of 4 Heaters KW 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: 10275 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 0 (Specify:) I certify,under the pains and penalties ofperjury,that the information on this ap licatlon is true and complete. FIRM NAME: E.F. WINSLOW PLUMBING &HEATING CO., I LIC.NO.:3281C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Alt.Tel.*Security System Contractor License required for this work;if applicable,enter the license number here: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 n owner's agent. Owner/Agent Signature Telephone No. I PERMIT FEE: $ E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _136,1 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, MA 02664 Phone#: 508-394-7778 Are you an employer? Check the appropriate box: Business Type(required): 1.❑■ I am a employer with 99 employees (full and/ 5. 0 Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. El 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.❑ Manufacturing no employees. [No workers' comp. insurance required]** 4.❑ We are a non-profit organization, staffed by volunteers, 11.El 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:01/01/2023 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 ce ' the ins and penalties of perjury that the information provided above is true and correct. Signature: 7Y .•�l� 12/01/2021 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 2.0 Building Department 3.❑City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia