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Home My WebLink AboutBLDE-22-006553 Commonwealth of Official Use Only Massachusetts Permit No. BLDE-22-006553 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 °LEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:5/16/2022 To the Inspector of Wires: City or Town of: YARMOUTH y this application the undersigned gives notice of his or her intention to perform the electrical work described below. .ocation(Street&Number) 16 AURORA LN Telephone No. )wner or Tenant Jeannie Donahue )wner's Address 16 AURORA LN, SOUTH YARMOUTH, MA 02664 Appropriate Box) s this permit in conjunction with a building permit? Yes 0 No (CheckCI 'urpose of Building Utility Authorization No. Volts Overhead 0 Undgrd 0 No.of Meters - existing Service Amps Vew Service Amps Volts Overhead 0 Undgrd 0 No.of Meters umber of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Install A/C. 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 KVA No.of Luminaire Outlets No.of Hot Tubs Generators �1 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 I No.of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices No.of Ranges No.of Air Cond. 1 Total No.of Alerting Devices Heat Pump I Number I Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices Local 0 Municipal. ❑ Other: No.of Dishwashers Space/Area Heating KW Connection Security Systems:* No.of Dryers Heating Appliances KWNo.of Devices or Equivalent NoNo.of No.of Ballasts Data Wiring: He Water KW Signs No.of Devices or Eauivalent Heaters Telecommunications Wiring: No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or Eauivalent 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.:o. 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 have the liability insurance coverage normally required by law.But my signature below,I hereby waive this requirement.I am the(check one) ❑ owner 0 owner's agent. Owner/Agent 'PERMIT FEE: $50.00 I Signature Telephone No. Commonwealth of Massachusetts Official Use Only tt Permit No. Z' S 3 !I � Department of Fire Services Occupancy and Fee Checked . ,,,' 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:05/09/2022 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)16 AURORA LANE, S.YARMOUTH, MA 02664 Owner or Tenant JEANNIE DONAHUE Telephone No. (781)718-5282 Owner's Address SAME Is this permit in conjunction with a building permit? Yes El No ❑✓ (Check Appropriate Box) Purpose of Building DWELLING Utility Authorization No. Existing Service Amps / Volts Overhead El Undgrd El No.of Meters New Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: AIR HANDLER&CONDENSER INSTALL ABOVE THE MAIN HOUSE. Completion of the following table mc9 be waived by the Inspector of Wires. otal No.of Recessed Luminaires No.of Ceil:Sus (Paddle)Fans Trano. s TVA P Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Pool Above In- No•of Emergency Lighting No.of Luminaires Swimming grnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones of No.of Switches No.of Gas Burners No. InDete and Initiatinnggon Devices No.of Ranges No.of Air Cond. roonsl No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: 1 3 Detection/Alerting Devices No.of Dishwashers Space/Area HeatingKW Local Municipal ❑Other P ❑Connection No.of Dryers Heating Appliances KW Security Systems:* �Y No.of Devices or Equivalent No.of'Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications NofDeice or qu v Y g No.of Devices Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 17745 municipal 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 and complete FIRM NAME: E.F.WINSLOW PLUMBING&HEATING CO., I LIC.NO.:3281C Licensee: RICHARD MELVIN Signature LIC.NO.:21829A (If applicable,enter "exempt"in the license number line.) Bus.Tel.No.:508-394-7778 Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02884 Alt.Tel.No.: *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 one)O owner n owner's agent. Owner/Agent I PERMIT FEE: $ Signature Telephone No. E.F.Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts Department of Industrial Accidents nimWeno =vigil= _ Office of Investigations Lafayette City Center _m 916 Mr % 2Avenue de Lafayette, Boston,MA 02111-1750 1 44, , 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 99 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]** 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 *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. #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 ce the ins and penalties of perjury that the information provided above is true and correct. Signature: I' "' -'�'�-� 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): 1.❑Board of Health 2.1=I Building Department 3.❑City/Town Clerk 4.0Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia