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Home My WebLink AboutBLDE-21-003990 Commonwealth of Official Use Only or€ Massachusetts Permit No. BLDE-21-003990 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev.l/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 perform the electrical work described below. Location(Street&Number) 19 GINGERBREAD LN Owner or Tenant DILZER ROBERT J JR TR Telephone No. Owner's Address REVOCABLE TRUST OF ROBT J DILZER JR, 19 GINGERBREAD LN,YARMOUTH PORT, MA 02675 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check •propriate Box) Purpose of Building Utility Authorization No. ? 2..y Existing Service Amps Volts Overhead 0 Undgrd ❑ P46.4.• •rs New Service Amps Volts Overhead 0 Undgrd ❑ N. •tos Number of Feeders and Ampacity Q 4Location and Nature of Proposed Electrical Work: Replacement of 200 amp meter socket. O Completion of the following table may ,, eta I s ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of tal Transformers A No.of Luminaire Outlets No.of Hot Tubs Generators VA No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency ' grnd. grnd. Battery Units A. No.of Receptacle Outlets No.of Oil Burners FIRE ALARM .o No.of Switches No.of Gas Burners No.of Dete on d 4 s,e Initiating evic qjy t Total ,� No.of Ranges No.of Air Cond. No.of Ale &�l es �D ;v Tons ,� 4, , *. No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Con eta (✓ , Totals: Detection/Alerting viC `'.� r F No.of Dishwashers Space/Area Heating KW Local 0 Municipa,_ & '-. 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 Commonwealth of Massachusetts Official Use Only !- ,,�_It_ Permit No.(: -3Ci� , Department of Fire Services 1( 9 Occupancy and Fee Checked 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 �C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 1/I Y /7/ City or Town of: Alma Ii4-1/0:;y - 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) /9 6,`,1 f I?t t d L z p i 41 i//- ' ' '-i c Owner or Tenant tier DI'/zp Telephone No.C(�j 625261 Owner's Address a+i.d/fr2Q Is this permit in conjunction with a building permit? Yes El No Er--(Check Appropriate Box) Purpose of Building 13 we [/t', Utility Authorization No. Existing Service Amps / Volts Overhead RI Undgrd❑ No.of Meters New Service Amps / Volts Overhead L Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 0 1' eta . acx'A m 12., -RC?1AC nivAn 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 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑Municipal ❑Other 1 Connection No.of Dryers Heating Appliances KW Security Systems:* - No.of vices or Equivalent No.of Water No.of No.of _ KWData 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: 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. 1N LD CHECK ONE: INSURANCE ® BOND ❑ OTHER El (Specify:) • O- I certify,under the pains and penalties of perjury,that the information on this ap lication is true and complete. a FIRM NAME: E.F.WINSLOW PLUMBING& HEATING CO., I LIC.NO.:3281 C 1 h/' Licensee: RICHARD MELVIN Signature LIC.NO.:21829A j 'S (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 Qj`v �- Address: 8 REARDON 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. I PERMIT FEE: $ The Commonwealth of Massachusetts " - '--- #_— Department of Industrial Accidents I�,L —,I Office of Investigations r __.45 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.❑� 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. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 8. ❑Non-profit [No workers' comp.insurance required] 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 a no employees. [No workers' comp.insurance required]** 11.0Health Care 4.❑ 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.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 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 nal0ties o perjury that the information provided above is true and correct. .».9 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): 1.0Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia