The URL can be used to link to this page

Home My WebLink AboutBLDE-21-006620 Commonwealth of n1\ Official Use Only fi (, At Massachusetts Permit No. BLDE-21-006620 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:5/17/2021 To the Inspector of Wires: City or Town of: YARMOUTH 3y this application the undersigned gives notice of his or her intention to pertorm the electrical work described below. Location(Street&Number) 10 COMPASS DR Telephone No. Owner or Tenant KEATING MICHAEL T Owner's Address KEATING SHARON A, 10 COMPASS DRIVE,SOUTH YARMOUTH, MA 02664 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: Install heat pump. 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 Above In- ❑ No.of Emergency Lighting No.of Luminaires Swimming Pool 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 Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat Pump I Number I Tons I KW No.of Self-Contained Totals: 1 Detection/Alerting Devices ❑ Municipal No.of Dishwashers Space/Area Heating KW LocalConne ion ❑ Other: Security Systems:* No.of Dryers Heating Appliances KW No.of Devices or Equivalent NoNo.of No.of Data Wiring: He Water KW Signs Ballasts No.of Devices or Equivalent Heaters 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. licensee INSURANCE COVERAGE:Unless waived by the owner,"completed opeo ration"t coverage r the ororots substantial electrical equrvalent The undersigned certifies that such provides proof of liability insurance including co p P coverage is in force,and has exhibited proof of same to the permit OTHER issuing office. (Specify:) CHECK ONE:INSURANCE 0 BOND 0 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 Signature Licensee: RICH"e MELVIN 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 have❑the o liability 0 owner'insurance s en coverage normally required by law.But er t. signature below,I hereby waive this requirement.I am the(check one) Owner/Agent PERMIT FEE: $50.00 Telephone No. Signature (Y,L 1-- 91.11 ( 1 \ Commonwealth of Massachusetts Official Use Only/ ------it,- .-------- t Permit No. .P,21 —CQ&10 =�_ i._ `,_�,,= Department of Fire Serrrices _•_._ Occupancy and Fee Checked t?='-( 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: S!5 /-z- l City or Town of: Yujvrntl.i 1-,1 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) 10 cosi P ci 5 5 Or S t Yhienad ad-4 DU o I C\1 Owner or Tenant C,r/tfil-e I, l{.ol1-ir0 Telephone No. 5 0 6 5 H ef00 0 Owner's Address 5IIWIR. Is this permit in conjunctiva with a building permit? Yes I I No I (Check Appropriate Box) Purpose of Building [)V46411 Utility Authorization No. Existing Service Amps / Volts Overhead I I Undgrd n No.of Meters New Service Amps / Volts Overhead n Undgrd I I No.of Meters Number of Feeders and Ampacity Q / / Location and Nature of Proposed Electrical Work: NiC'�"I.e 5S ileal f— /Vvrlid M5J Nil oh 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 Above In- No.of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. I I 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 No.of Air Cond. Total No.of Alerting Devices No.of Ranges Tons No.of Waste Disposers Heat P ump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices Space/Area heating KW Local Municipal I I Other No.of DishwashersI I Connection Heating Appliances KW SecuritySpstems:* No.of Dryers No.of Devices or Equivalent No.of'Water KWNo.of No,of Data Wiring: Heaters Signs Ballasts No.of Devices or equivalent Telecommunications Wiring. No.Ilydromassage Bathtubs No.of Motors Total AP No.of Devices or Equivalent O OTHER: V. 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 ❑ OTHER ❑ (Specify:) V` I certify,under the pains and penalties ofpeifury,that the information on this ap lication is true and•complete. CJ FIRM[NAME: E.F.WINSLOW PLUMBING & HEATING CO., .LIC.NO.:3281 C I. l/") Licensee; RICHARD MELVIN Signature LIC.NO.:21829A N �1' (If applicable, enter "exempt"in the license number line.) Bus.Tel.No.:508-3947778 Address; a REARIDON CIRCLE SOUTH YARMOUTH,MA o2ee4 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)jJ owner E 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 IndustrialAccidents i='Z r Office of Investigations ,��w•r}: Lafayette City Center e 2 Avenue de Lafayette,Boston,MA 02111-1750 ), ' s' 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): 1.11 I am a employer with 90 employees (full and/ 5. ❑Retail or part-time).* 6. n Restaurant/Bar/Eating Establishment 2.1 1 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.n We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152, §1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]** 4.1 I We are a non-profit organization, staffed by volunteers, 11.[]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. Lie.#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 ' 1e1•the ins and penalties of perjury that the information provided above is true and correct. Signature: 7' ~* �(/ l 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): l f Board of Health 2.0 Building Department 3.111 City/Town Clerk 4.[]Licensing Board 5.nSelectmen's Office 6.[]Other Contact Person: Phone#: www.inass.gov/dia