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Home My WebLink AboutBLDE-22-007200 Official Use Only in (y. Commonwealth of Massachusetts Permit No. BLDE-22-007200 • 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:6/14/2022 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) 256 LONG POND DR Owner or Tenant BOULETTE CHRISTINE C Telephone No. Owner's Address BOULETTE SHANE M, 256 LONG POND DRIVE, SOUTH YARMOUTH, MA 02664 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: Install generator 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 1 KVA 14 SwimmingPool Above ❑ In- ❑ No.of Emergency Lighting No.of Luminaires grnd. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Ton Heat Pump I Number I Tons 1 KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Local ❑ Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Eauivalent No.of Water No.of No.of Ballasts Data Wiring: KW Signs No.of Devices or Equivalent Heaters 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. 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 LIC.NO.: 21829 Licensee: RICH M MELVIN Signature (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:Alt.Tel.No.: Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 *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 the(checkone) 0 owner icnse ds not havetheia ity insurance❑ owner'coverage en normally required by law.But my t. signature below,I hereby waive this requirement.I Owner/Agent PERMIT FEE: $50.00 Telephone No. Signature Sr-atiV1-3-7& -6-'AnOt 611-21741 g' (-00(,4 ) F � Commonwealth of Massachusetts Official Use Only * Permit No. ---77 IM �; t Department of Fire Services -. Occupancy and Fee Checked T - 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: 6/9/2022 City or Town of: YARMOUTH(SOUTH) 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) 256 LONG POND DR, S YARMOUTH, MA 02664 Owner or Tenant CHRISTINE ROULETTE Telephone No. (508)398-9470 Owner's Address SAME Is this permit in conjunction with a building permit? Yes El No El (Check Appropriate Box) Purpose of Building DWELLING Utility Authorization No. Volts___ Overhead_ Undgrd❑ No.of Meters -- New_Existing Service Amps.. _-----10 Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 14KW(16)ESSENTIAL CIRCUIT GENERATOR 18"OFF OF THE FENCE ON THE RIGHT REAR SIDE OF THE HOME. Completion of the following table may be waived by the Inspector of Wires. No.of TT l No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators 1 KVA 14 Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS INo.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Alerting Devices No.of Ranges No.of Air Cond. Tons Heat Pump Number f Tons IKW No.of Self-Contained No.of Waste Disposers Totals: 1 Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municipal Connection ❑Other Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: KW Ballasts No.of Devices or Equivalent Heaters Signs Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Equivalent q OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1 0440 (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 of perjury,that the Information on this ap lication is true and LIC. mplNO.e 3. C FIRM NAME: E.F.WINSLOW PLUMBING &HEATING CO., I LIC. •NO.:21829A21 Licensee: RICHARD MELVIN Signature 50 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: ____ _ Alt.Tel.No.: Address: a REARDON CIRCLE SOUTH YARMOUTH,MA 02664 *Security System Contractor License required for this work;if applicable,enter the license number here: —___._— y OWNER'S INSURANCE WAIVER: below, hereby waive phis requirement. I am the(check one msuoN'ner rance overaogWner�allent. required by law. By my signature Owner/Agent Telephone No. PERMIT FEE: $ Signature E.F.Winslow Inspection Department email inspections@efwinslow.com The Commonwealth of Massachusetts _.._ Department of Industrial Accidents x=f` i Office of Investigations _® l _ Lafayette City Center y 2 Avenue de Lafayette, Boston, MA 02111-1750 "`, `` 1' wwx.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 0 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, [' Office and/or Sales (incl.real estate, auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. 0 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]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *My 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 cer ' e the ins and penalties of perjury that the information provided above is true and correct. � 12/01/2021 Signature: Y is ...�A .. , 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): 10Board 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