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HomeMy WebLinkAboutBLDE-22-004722 ,.- �■�, i... Commonwealth of Official Use Only k. �� Massachusetts Permit No. BLDE-22-004722 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:2/25/2022 City or Town of: YARMOUTH To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to performa electrical work descri ed beloyv. _ �� Location(Street&Number) 71 DIANE AVE �4- 'a ' L/h/t J'1 Owner or Tenant Telephone No. Owner's Address P ...— - - -. - __.. ---_ .__ _. 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 generator. 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 1 KVA 10 No.of Luminaires Swimming Pool Above ❑ In- ❑ No.of Emergency Lighting god. grnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Ton No.of Waste Disposers Heat Pump Number Tons J KW No.of Self-Contained Totals: Detection/Alertine 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 Eauivalent No.of Water KW No.of No.of Ballasts Data Wiring: Heaters Siens No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: 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 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: DWNER'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) 0 owner 0 owner's agent. Dwner/Agent Signature Telephone No. 'PERMIT FEE:$50.00 $,z ( 7) %eCt 6xY2 cit �� w616)c c CaYM:c a, Wi'OPleti 3 14,102,55 R 4v . GS7. 1( � 4u4 0 oe1Z�- ` C t ACommonwealth of Massachusetts Official Use Only ►(- t Department of Fire Services Permit No. �GZ.'Z� ��i�i v - EOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _'',. �a+ [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 RV INK OR TYPE ALL INFORMATIOII) Date:02/18/2022 City or Town of: YARMOUTH(SOUTH) To the Inspector of By this application the undersigned gives notice of horis her intention to perform the electrical work dtescribed below. Location(Street&Number)71 DIANE AVE , S YARMOUTH, MA 02664 Owner or Tenant JONATHAN LOWRY Owner's Address SAME Telephone No. (845)274-2866 Is this permit in conjunction with a building permit? Yes ❑ No El Purpose of Building SINGLE DWELLING (Check Appropriate Box) Utility Authorization No. Existing Service Amps / Volts Overhead 0 Undgrd❑ No.of Meters New Service Amps / Volts Overhead Number of Feeders and Ampacity ❑ Undgrd❑ No.of Meters Location and Nature of Proposed Electrical Work: 10KW WHOLE HOUSE GENERATOR 18"OFF OF THE FENCE ON THE BACK RIGHT SIDE OF THE HOME Com.letion o the ollowin_ table m. be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Sus o.of p.(Paddle)Fans Transformers Total No.of Luminaire Outlets KVA No.of Hot Tubs Generators 1 KVA 1 0 No.of Luminaires Swimming Pool Above In- `o.o mergency ig Ong :rnd. ❑ 1 rnd. ❑ Batte Units No.of Receptacle Outlets No.of Oil Burners E - Zones ALARMS No.of Zones No.of Switches No.of Gas Burners o.o etechon an No.of Ranges Initiatin, Devices No.of Air Cond. ota Tons No.of Alerting Devices No.of Waste Disposers eat Pump • Tons '� Totals: •• •••••••••.•• o.o Self- ontamed No.of Dishwashers Detection/Alertin, Devices Space/Area Heating KW Local Municipal ❑No.of Dryers Connection El Other - ----------__-- Heating Appliances Kam, Security stems No.of Water No.of No.of Devices or E,uivalent Heaters KW No.of Data Wiring: Si.Ins Ballasts No.of Devices or E 1 uivalent No.Hydromassage Bathtubs_ No.of Motors Total HP Telecommunications 'ring: OTHER: No.of Devices or E I uivalent Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 8600 Work to Start: (When required by municipal policy.) 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 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 Licensee: RICHARD MELVIN LIC.NO.:3281 C Signature (If applicable,enter "exempt"in the license number line.) Bus.Tel.No. Address: 8 REARDON CIRCLE SOUTH YARMOUTH,MA 02884 508-394-7778 :LIC.NO.;21829A *Security System Contractor License required for this work;if applicable,enter the license number here: : Alt.Tel.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally by law. By my signature below,I hereby waive this requirement. I am the(check one owner Owner/Agent y Signature �owner's a�ent. Telephone No. PERMIT FEE:$ E.F. Winslow Inspection Department email : inspections@efwinslow.com The Commonwealth of Massachusetts —'--,f Department of Industrial Accidents ' ` _ ' Office of Investigations ,r- 1�i „ —"�K Lafayette City Center ✓" r' 2 Avenue de Lafayette, Boston,MA 02111-1750 ter.M_*.✓Y,`), 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.El I am a employer with 99 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. ❑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.❑ 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. #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 cer ' e the ins and penalties of perjury that the information provided above is true and correct. Signature: ?-~ /... .-.. 12/0 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): 10Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.OLicensing Board 50 Selectmen's Office 6.0 Other Contact Person: Phone#: www.mass.gov/dia