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Home My WebLink AboutBLDE-22-003108 Commonwealth of Official Use Only fi..Alk Massachusetts Permit No. BLDE-22-003108 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:11/30/2021 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) 14 CLEAR BROOK RD Owner or Tenant Shari Page 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 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: Split heat pump system. 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 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 Gas Burners No.of Detection and No.of Switches Initiating Devices No.of Air Cond. Total No.of Alerting Devices No.of Ranges Ton Heat Pump Number Tons 1 KW No.of Self-Contained No.of Waste Disposers Totals: 1 Detection/Alerting Devices 0 Municipal ❑ Other: No.of Dishwashers Space/Area Heating KW LocalConnection Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or Equivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Signs No.of Devices or Eauivalent 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 Bus.Tel.No.: (If applicable,enter"exempt"in the license number line.) 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 License does not have0 the owner liability 0insurance owner's en coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) t. Owner/Agent PERMIT FEE: $50.00 Signature Telephone No. Commonwealth of Massachusetts Official Use Only * t Permit No. -ZZ- 3( bi , /sl a Department of Fire Services Occupancy and Fee Checked -1 v 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: 11/24/2021 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) 14 CLEAR BROOK RD,W.YARMOUTH, MA 02673 Owner or Tenant SHARI PAGE Telephone No. (508)360-5532 Owner's Address 265 COMMUNICATIONS WAY,#440, HYANNIS, MA 02601 Is this permit in conjunction with a building permit? Yes 0 No 0 (Check Appropriate Box) Purpose of Building RESIDENTIAL SINGLE DWELLING Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps I Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: DAIKIN HEAT PUMP SYSTEM WALL MOUNTED INSIDE BASEMENT FAMILY ROOM&CONDENSER ON STAND OUTSIDE Completion of the following table my 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 KVA No.of Luminaires Swimming Pool Above In- No.of l mergency Lighting grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS (No.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 I 1 Number I Tons KW No.of Self-Contained No.of Waste Disposers Totals: 2 i Detection/Alerting Devices Municipal Other No.of Dishwashers Space/Area Heating KW Local Connection El HeatingSecurity Systems:* No.of Dryers Appliances KW No.of Devices or Equivalent No.of Water No.of No.of Data Wiring: Heaters Signs KW Ballasts No.of Devices or Equivalent 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: 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 0 OTHER 0 (Specify:) I certify,under the pains and penalties of perjury,that the information on this ap lication is true L complete. 3 C FIRM NAME: E.F.WINSLOW PLUMBING &HEATING CO., I LIC.NO.:3282_CA Licensee; RICHARD MELVIN Signature __3829A Bus.Tel.No.• 94-7778 (If applicable,enter "exempt"in the license number line.) Alt.Tel.No.: Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 *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 on owner $PERMIT FEE: owner's a ent. Owner/Agent Telephone No. Signature E.F.Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations =" = Lafayette City Center • 116 WIN 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 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. ❑ 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.ElWe are a non-profit organization, staffed by volunteers, 11.❑ Health Care with no employees. [No workers' comp. insurance req.] 12.❑ 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:01/01/2022 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 cer • r/ the ins d penalties of perjury that the information provided above is true and correct. Signature: Y,f"~ "�- 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.❑Building Department 30 City/Town Clerk 4.❑Licensing Board 5.❑Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia