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Home My WebLink AboutBLDE-21-001050 or it) Commonwealth of Official Use Only LI% • Massachusetts Permit No. BLDE-21-001050 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:8/31/2020 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) 89 BAKER RD Owner or Tenant BRADLEY KEVIN B . Telephone No. Owner's Address BRADLEY JULIE A,700 ROUTE 22, PAWLING, NY 12564 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 ■ No.of A� New Service Amps Volts Overhead 0 Undgrd �� .of Number of Feeders and Ampacity * Q Location and Nature of Proposed Electrical Work: Installation of manual transfer switch. bv6 ›,.� ..._ Completion of the fo . Pg / tp.• a d 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 gr bovend. ❑ grnd ❑ No.of Emergency Lighting Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 1 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons 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 0 Municipal 0 Other: Connection No.of Dryers Heating Appliances KW Security Systems:* No No.of Devices or Equivalent HeatersWater 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: RICH M MELVIN Licensee: Rich M Melvin Signature LIC.NO.: 21829 (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.: Address:8 REARDON CIR, S YARMOUTH MA 026641207 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. I PERMIT FEE:$50.00 I NI) A t Il 2 (u k A Commonwealth of Massachusetts Official Use Only * �, Permit No.eczA -(.0 0 u' ' Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked -"r [Rev.9/05] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR ALL IN ORNIATION) Date: j ZC/ZO B City or Town of: )PE///7a// 1 To the Inspector of Wires: y this application the undersigned gives notice f his or ler in ntion to perform the electrical work described below. Location(Street&Number)g� �akf[K U t�,P,I-ra aud141 Owner or Tenant 641 Brqdie y Telephone No. ,505 77$r-JUoG Owner's Address 100 Kovit as pn.W(ih r7 N Y J ( y Is this permit in conjunction with a building permit? Yes ❑ No a" (Etreck Apprupriate ppriipriate Box) Purpose of Building b Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd g 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: cultic( i ckiu1t 5 f fir '' itli rh I,/S/_'�4- /U4 Completion of the.tollowingtable 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 INo.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 No.of Waste Disposers Heat Pump I Number [Tons I KW No.of Self-Contained Totals: Detection/Alerting Devices d No.of Dishwashers Space/Area Heating KW al 0 Municipnnecti on al ❑Other Co No.of Dryers Heating Appliances KW Security Systems:* No.of Water No.of No.of Devices or Equivalent Heaters KW No.of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wirin 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. M 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 0 OTHER Ni 0 (Specify:) O I certify,under the pains and penalties o perjury,that the information on this ap lication is true and complete. • FIRM NAME: E.F. WINSLOW PLUMBING&�HEATING`CO., I 1- p Licensee: RICHARD MELVIN LIC.NO.:3281 C Signature LIC.NO.:21829A (/fapplicable,enter "exempt"in the Ncense number line.) Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02884 Bus.Tel.No.:508-384-7776 *Security System Contractor License required for this work;if applicable,enter the license numbAlt. er 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 owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE: u The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 wwwmass.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 90 employees (full and/ 5. ❑ Retail 2.❑ or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 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. El Non-profit 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152, §1(4),and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 4.❑ We are a non-profit organization, staffed by volunteers, 11.0 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.#1909A 01/01/2021 Expiration Date: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). 1'ailu,-e 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 theghins and penalties of perjury that the information provided above is true and correct. Signature: r w► �7/...•l.•.r- Date: 01/02/2020 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): 1.12Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.[]Other Contact Person: Phone#: www.mass.gov/dia