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Home My WebLink AboutBLDE-21-003640 Commonwealth of Official Use Only l` 1%. Massachusetts Permit No. BLDE-21-003640 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:1/4/2021 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 188 PINE GROVE RD Owner or Tenant RISPIN DIANE Telephone No. G Owner's Address 188 PINE GROVE RD, SOUTH YARMOUTH, MA 02664 %7 Is this permit in conjunction with a building permit? Yes 0 No 0 (Che, :*i,' op , )1t) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgrd 0 .40,-, f . New Service Amps Volts Overhead 0 Undgrd 0 No. , k. eer Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Replacement furnace. 41:6)Completion of the following table may be waived by the Inspector ofWires. 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 0 In- ElNo.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 1 No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained 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.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Siens 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 ❑ (Specify:) I certify,under the pains and penalties of perjuly,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 Pp-Avec- sp ) _ ,= commonwealth of Massachusetts Official Use Only Lk in' Department of Fire Services Permit No. �='Z '��n lc-1-`` BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked 4w [Rev.9/OS] (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 Tr?'E ALL INFORMATION) Date: 2 J Z t 1 t O City or Town of: %fi'ndih, To the Inspector of Wires: By this application the !A_ n undersigned_gives notice/of his or er intention to perform the electrical work described below. Location(Street&Number) \ 1)`At (�foli� ,(, �G_IAA tCl.f 14U/ !�l/ Owner or Tenant (),N V�SA Telephone No. 5643 q v/3 39 Owner's Address CiAte Is this permit in conjunctionwith building a permit? Yes n No (Check Appropriate Box) Purpose of Building t h GJ I Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g n No.of Meters New Service Amps / Volts Overhead n Undgrd n 1; i I No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: /f'7I7 (e (n5)41towi'co • 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. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners '• ' Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: I I { Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKWMunicipal Local 0 Connection EL Other 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 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. CHECK ONE: INSURANCE ® BOND 0 OTHER ❑ (Specify:) I certify,under the pains and penalties operjury, fthat the information on this application is true and complete. c FIRM NAME: E.F. WINSLOW PLUMBING & HEATING CO., IN LIC.NO.:3281C #- Licensee: RICHARD MELVIN Signature (If applicable, enter "exempt"in the license number line.) LIC.NO.:21829A T Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02664 Bus.Tel.No.: 508-394-7778 _N JAlt r *Security System Contractor License required for this work;if applicable,enter the license number here:No.: 1 c 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. t.,„j Owner/Agent Signature Telephone No. I PERMIT FEE: $ I o_. Department of In(tustrlalAccidents �-'� 4. .Office of Investigations Lafayette City Center ,• .• 2Avenue de.L,afayette,Boston,MA 021112750 , • wwwmass.gov/dla. . Workers' Compensation XnsuranceAffidavits General Businesses Applieantxnfor•mation 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.El I am a employer with 80 employees(fhll and/ 5. .0 Retail or part-time).* 6, r]Restaurant/Bar/Eating Establishment 2,❑ I am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(lncl,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 a. 152,§1(4),and we have 10,0 Manufacturing no employees. [No workers' comp.insurance required]'* 11.0'S ealtlf 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#I must also fill out the section below showing their workers'compensation policy Infonnatio i, *'If the corporate officers have exempted'themseives,but the corporation has other employees,a workers'compensation policy is required and such an organization should plink 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 Tncnrer'e AJMtiresS: • City/State/zip: • Policy#or Selans,Lie,#1909A Expiration Date;01/01/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to securct coverage as•required under§25A:of MOL 0.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 ancc/or one-year imprisonment, as well as civil penalties in the.form of a STOP'WORSE 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 insurhnea coverage Verification, .1 do hereby der ' el the ins and penalties ofperjury that the 'information provided above is true and correct, Signature: km, ,k..f,. 01/02/2020 bate: • Phone#: 608-394.7778 Official use o sly Do not write In this area,,to be completeal by city or toOn official. City or Town:', Permit/License# Issuing Authority(check ono); 1.1:1Doard of I reaith 2.0 Building Department 3.0 City/Town Clerk 4.0.,icensing Board 5[(Selectraonas Office 6.DOtlieir Contact rers4n: • . Phone#; www,mass,gov/dia • •