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Home My WebLink AboutBLDE-23-000193 Commonwealth of Official Use Only fil' Massachusetts Permit No. BLDE-23-000193 BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked JRev.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:7/12/2022 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) Aildstres117S`RD j� U �' S'� Owner or Tenant Kathleen Sage 1 Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 100 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: U.•rade sery a 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 Initiative Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alertine 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 Ballasts Data Wiring: Siegs 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 ❑ I certify,under the pains and penalties o perjury,u that the information on this application Jcation is true and complete. FIRM NAME: E F WINSLOW PLUMBING HEATING CO INC Licensee: RICH M MELVIN Signature LIC(If applicable,enter"exempt"in the license number line.) Tel. NO.: 21829 Address:8 REARDON CIRCLE, SOUTH YARMOUTH MA 02664 Bus.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Alt.Tel.No.: 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. Owner/Agent Signature Telephone No. PERMIT FEE:$50.00 Ca CSte(5t Z,' , -. n 11434uj(1U-C A Commonwealth of Massachusetts Official Use Only r :, t Department of Fire Services Permit No. C.�-� 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: 7/7/22 City or Town of: YARMOUTH To e 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)36 RIVER STREET Owner or Tenant KATHLENE SAGE Owner's Address SAME Telephone No. 860-334-8781 Is this permit in conjunction with a building permit? Yes ❑ Purpose of Building DWELLING No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd 0 No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity El Undgrd 0 No.of Meters Location and Nature of Proposed Electrical Work: 100 AMP SERVICE Completion of the followin:table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Sus . o.of Total p (Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool ' 'ove In- `o.o rnd. ❑ yig g No.of Receptacle Outlets Batte Units m rnd. No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners `o.o etectron an No.of Ranges Initiatin 1 Devices No.of Air Cond. oth Tons No.of Alerting Devices No.of Waste Disposers eat 'ump um er Totals: ......-....-ons ....... i c, `o.o Se f- ontame No.of Dishwashers Detection/Alertm Devices Space/Area Heating KW unici aln ❑ No.of Dryers Heating Appliances Kam, Security Cystem tipOther `o.of ater No.of Devices or E i uivalent Heaters KW o.o `o.of Data Wiring: Si 1 ns Ballasts No.of Devices or E 1 uivalent No.Hydromassage Bathtubs No.of Motors Total HP a ecomfDevic roes "rim : OTHER: No.of Devices or E.uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Work to Start: (When required by municipal policy.) 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 ap lication is true and complete FIRM NAME: E.F. WINSLOW PLUMBING &HEATING CO., I Licensee: RICHARD MELVIN LIC.NO.:3281C (If applicable,enter "exempt"in the license number line.) Signature LIC.NO.:21829A Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.:509-384-7778 *Security System Contractor License required for this work;if applicable,enter the license number here: Alt.Tel.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 III owner Iowner's a:ent. Owner/Agent Signature Telephone No. PERMIT FEE:$ E.F. Winslow Inspection Department email : inspections@efwinslow.corn The Commonwealth of Massachusetts Department of Industrial Accidents "' ' Office of Investigations t at Lafayette City Center '�% 2 Avenue de Lafayette,Boston,MA 02111-1750 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): 1.11 I am a employer with 99 employees (fill and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7employees working for me in any capacity. ❑ Office and/or Sales(incl.real estate,auto,etc.) [No workers' comp. insurance required] 8. El 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.ElWe are a non-profit organization, staffed by volunteers, ME Health Care with no employees. [No workers' comp. insurance req.] 12.EI 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 cery• the ins and penalties of perjury that the information provided above is true and correct. Signature: Y '` ...AL" Date: 12/01/2021 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): 10Board 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